Hypoactive Sexual Desire Disorder is the diagnosis given to those individuals who experience very low or no desire for sexual activity. The disorder can be lifelong or acquired. It can be true in all situations or specific to certain sexual situations. A thorough sexual history is needed for the clinician to determine cause and course of treatment.
Initially, it should be determined if a medical condition is causing the lack of desire. Hormone imbalances, medication side effects, and pain during sexual activity are all factors to be considered. A consultation with a primary care physician can determine if a referral to an Urologist or Gynecologist is necessary.
If no medical explanation exists, the cause is likely psychological or relational. A qualified sex therapist can assess the individual and his/her partner during a clinical interview to determine what factors are contributing to the problem. Some common psychological factors include depression, anxiety, a history of sexual abuse or shame about one’s sexuality or sexual behavior.
The problem is relational if it is a symptom of unresolved conflict between the individual and his/her partner. Anger, distrust, and loss of respect for the partner can cause a loss of sexual desire. The individual may continue to have a drive to be sexual, just not with the partner. Inquiring about the frequency of masturbation can help make this determination.
In my own practice, I see this disorder more frequently in women than men. It is most difficult to treat when it has been lifelong and the individual has no history of healthy sexual desire to compare to. In these cases the motivation for change is usually low and the client may be participating in treatment only at the insistence of a partner.