Hsdd and Its Impact on Sexual Desire

Female hypoactive sexual disorder occurs in roughly one-third of adult women in the United States (Basson, 2000). The foundation of HSDD is predicated on a deficiency of sexual fantasies or desires for sexual activity. Ultimately this lack of desire causes females to experience marked distress and difficulty with interpersonal relationships. Evaluation and subsequent treatment for this disorder can be become very contentious. Treatment requires careful and thoughtful consideration of the patient and the litany of influences that impact female sexual desire. For example, many female life experiences may uniquely impact the overall sexual desire of the female. Events, including the menstrual cycle, hormonal contraceptives and postmenopausal states all contribute to the overall complexity of treatment. In particular, sexual dysfunctions in women have a strong correlation to low feelings of happiness and emotional satisfaction. Generally, theses feelings occur with women who are in a relationship. Logically, one of the most common treatments occurs with counseling both parties who are in the relationship. With therapy, the therapist tries to locate either the psychological or biological cause of the distress. Treatment typically consists of a focus on communication, working on non-sexual intimacy and education. In regards to locating the biological cause of HSDD, therapists are now focusing much more of their time on the endocrine factors of a women's sexual behavior. The impacts of endocrine factors in a women's sexual functions have been recently revised, creating much more complexity with treatment. In addition, the distinct effects of estrogens and androgens on sexual desire and receptivity are still not completely understood. However, the research evidence provides clear evidence that the endocrine milieu plays a critical role in setting the threshold to sexual stimuli.

Hormone therapy with an emphasis on estrogen is used for treatment of women experiencing menopause. Studies have also found that using estrogen for treatment is effective for vulvovaginal atrophy due to an increase in lubrication. Unfortunately hormone therapy is not the complete solution, as it does not have a positive impact on women with surgical menopause. The side effects of this treatment are mild, consisting of excess hair growth, increase prevalence of acne, and a decrease in high-density lipoprotein (Brotto, 2010).

Another potential option of HT for HSDD is tibolone, a synthetic steroid not available in the U.S. This treatment is some controversial, as results have been mixed to date. In essence Tibolone lowers sex hormone-binding globulin and increases circulating free testosterone. Apart from alleviating postmenopausal vasomotor symptoms and improving urogenital atrophy, some studies suggest that tibolone is effective in postmenopausal women with symptoms of sexual dysfunction. In a recent multicenter, double-blind, randomized, clinical trial, tibolone improved sexual well-being in postmenopausal women with low libido with improvements in desire arousal, satisfaction, and receptiveness, compared to those receiving transdermal estrogen-progestin therapy. Even with tibolone some concerns have been raised about long-term use and risk of cardiovascular disease and/or breast cancer. Some results have shown that excessive use can create an increased likelihood of breast cancer (Sand, 2007).

Finally, plant-derived and other herbal remedies have been used to treat HSDD. Unfortunately, these forms of treatment have not been proven to be effective a curing HSDD.