Hypoactive sexual desire disorder (HSDD) is a condition in which people lack sexual desire or have a low libido, and it causes them distress. It can be a long-term condition or arise only in certain situations.
A healthcare professional can determine the underlying cause of HSDD, and treatment can help people return to experiencing a positive and satisfying sex life.
This article examines the symptoms, causes, diagnosis, treatment, and outlook of HSDD.
A note about sex and gender
Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.
HSDD stands for hypoactive sexual desire disorder. “Hypoactive” means inactive or underactive.
People with HSDD lack sexual desire, which causes difficulties. HSDD typically causes a person distress or creates issues in sexual relationships.
HSDD may happen gradually, be a long-term issue, or only occur in certain situations.
HSDD can affect people of any sex or gender, but it most commonly affects females. Research suggests that continuous HSDD affects 22% of females and 5% of males.
It is one of the most common sexual issues affecting females, with about 1 in 10 females reporting having HSDD.
Symptoms of HSDD include:
- little to no sexual desire
- little to no sexual thoughts or fantasies
- a reduction in sex drive compared to previous levels
- does not respond to sexual suggestions or signals from a partner
- does not initiate sexual activity with a partner
- experiencing no arousal
- loss of interest in masturbation
- loss of sexual desire during sex
- premature orgasm or lack of orgasm during sexual activity
- avoiding sex
A characteristic of HSDD is a person experiencing distress or difficulties in their relationships due to the above symptoms.
Males with HSDD may experience a loss of erectile or ejaculatory function.
HSDD may affect up to 15% of males.
The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), which healthcare professionals use to diagnose mental health conditions, has now reclassified HSDD.
HSDD was previously gender-nonspecific, but the DSM-5-TR now uses the term male hypoactive sexual desire disorder (MHSDD) to diagnose males only.
Depending on the symptoms present, there are different subtypes of MHSDD that a person may have:
- Lifelong/generalized: An individual never had any interest in sexual activity, either alone or with a partner.
- Acquired/generalized: A person has previously had sexual desire for their partner but now has no interest in sexual activity with any partner or alone.
- Acquired/situational: An individual has previously had sexual desire for their partner but now no longer does. They have an interest in sexual activity alone or with a different partner.
The DSM-5-TR now uses the term female sexual interest/arousal disorder (FSIAD) to diagnose HSDD in females, but certain organizations or healthcare professionals may still use the terms interchangeably.
Females with HSDD may experience a lack of sexual thoughts or fantasies and a reduced or nonexistent libido that affects them negatively.
Doctors may only diagnose HSDD if another medical condition or medication may be causing the symptoms.
A low sex drive, or low libido, refers to a reduced interest in or desire for sex.
HSDD can be a cause of low libido, but they are not the same condition. Low sex drive is usually a symptom of an underlying condition, not a condition itself.
The key difference between the two is that people with a low sex drive may not experience any distress from it.
HSDD occurs when people have a low sex drive and feel distressed about it, or it is causing difficulties within a sexual relationship.
Possible causes of HSDD include:
- physical conditions, such as diabetes, depression, thyroid issues, and multiple sclerosis (MS)
- an imbalance of chemicals in the brain that links to sexual desire
- side effects of certain medications, such as some antidepressants or high blood pressure drugs
- relationship issues, such as conflict or lack of trust
- body image issues or low self-esteem
- anxiety, depression, or other psychological conditions
Risk factors of HSDD may include:
- low testosterone levels
- low estrogen levels
- high levels of prolactin
- inflammatory bowel disease (IBD)
- alcohol use
- heart disease
- kidney disease
- history of abuse, trauma, or sexual assault
To diagnose HSDD, a doctor may take a medical history, assess symptoms, and take a physical exam. The physical exam may help to rule out any physical causes of HSDD symptoms.
A doctor or mental health professional may then perform a range of psychological assessments, such as questionnaires or talking sessions. This can help healthcare professionals better understand a person’s mental health history and current mental state.
To diagnose MHSDD or FSIAD, healthcare professionals may use diagnostic criteria from the DSM-5-TR.
Depending on the underlying cause, different approaches, and sometimes a combination of methods, can help treat HSDD. Treatments may include:
- lifestyle changes, such as stress management, dietary changes, and exercise
- counseling or psychotherapy
- cognitive behavioral therapy (CBT)
- sex therapy
- hormonal therapies
Psychotherapy may help if a person has a psychological cause for HSDD.
If people have concerns about their relationship or a psychological condition that is causing a lack of sexual desire and distress, psychotherapy may help.
People may use talk therapy or cognitive behavioral therapy (CBT), a type of psychotherapy that focuses on strategies to change unhelpful patterns of thought or behavior.
Sex therapy is a type of counseling that helps people work through sexual difficulties. People with HSDD may attend sex therapy alone or with a partner.
Sex therapy may include discussing a person’s sexual background and education alongside the beliefs and concerns a person has about sex.
A therapist may also give a person or couple some tasks to carry out at home, such as:
- experimenting with sex, such as using role play, sex toys, or different positions
- working gradually through different stages of touch to build trust and intimacy
- sex education via books, videos, or websites
- improving communication about sexual and emotional desires and needs
Depending on the underlying cause, some medications may help to treat HSDD.
If a hormone deficiency is causing HSDD, people may require hormone replacement therapy. Females with HSDD may take estrogen therapy, which supports libido. If males are low in testosterone, they may need testosterone therapy to increase their sex drive.
Flibanserin is another type of medication suitable for people who are premenopausal and have HSDD. Flibanserin helps to balance chemicals in the brain that link to sexual excitement. People take flibanserin orally once a day to increase sexual desire.
People can discuss any possible side effects of medications with a healthcare professional.
Once a healthcare professional has found the underlying cause of HSDD, treatment can help people recover from the condition and return to having a positive and satisfying sex life.
There is currently no definite way to prevent HSDD. Early treatment of the condition may help to relieve symptoms and reduce the risk of people experiencing complications.
Taking steps to reduce risk factors within a person’s control, such as making lifestyle choices to reduce disease risk, may help.
If a person thinks they may have HSDD, they can consult a healthcare professional for a diagnosis.
If a lack of sexual interest or desire is causing distress or issues within a relationship, it is important to determine the underlying cause and seek treatment.
This section answers some common questions about HSDD.
How do you test for hypoactive sexual desire?
A healthcare professional may perform a physical examination and psychological assessments to test for HSDD.
To diagnose MHSDD or FSIAD, healthcare professionals may use the DSM-5-TR to check a person meets the specific diagnostic criteria.
Who is affected by hypoactive sexual desire disorder?
People of any sex, gender, or ethnicity can have HSDD, although it is more common in females.
Some people may have HSDD as a long-term issue, while others may experience it after certain situations, such as pregnancy, low self-esteem, or stressful life events.
As people age, hormone levels can change. Low testosterone levels in males or people going through menopause may experience a drop in libido, which may cause distress.
How many people have hypoactive sexual desire?
Some research suggests that up to 40% of females will receive an HSDD diagnosis at some point. It is the most common type of sexual dysfunction affecting females.
Around 15% of males may experience HSDD.
HSDD is a lack of sexual desire that causes a person distress or relationship difficulties. HSDD can affect people of any gender but is more common in females.
Treatment depends on the underlying cause but may include lifestyle changes, therapy, or medications.
Early diagnosis and treatment of the condition can help people relieve symptoms and regain a healthy sex life.