JoAnn V. Pinkerton, MD

A This disorder is prevalent in women at all reproductive stages. Younger, surgically postmenopausal women were at greatest risk among 4 demographic groups analyzed (TABLE). Prevalence ranged from 26% in surgically postmenopausal women aged 20 to 49, to 9% in naturally postmenopausal women.

Hypoactive sexual desire disorder (HSDD) should be recognized as an important quality-of-life issue, particularly for those at increased risk, this report concluded. WISHeS is the first study to report the prevalence of HSDD in US women using well-validated questionnaires, and to assess sexual, relationship, and quality-of-life correlates. Psychosocial distress and significant decrements in general health status, including aspects of mental and physical health, were linked to HSDD.

TABLE

Hypoactive sexual desire disorder rates in US women

AGE 20–49	%
Premenopausal	14
Surgically menopausal	26
AGE 50–70
Naturally postmenopausal	9
Surgically postmenopausal	14

What makes hypoactive sexual desire a disorder?

HSDD is diminished desire for sexual activity, including sexual fantasies. It is considered a disorder only if it causes marked distress for the patient or serious interpersonal relationship problems.

HSDD is associated with these problems:

• greater emotional and psychological distress,
  
• lowered sexual and partner satisfaction, and
  
• diminished general health, both mental and physical.
  

Details of the study

The findings were derived from a cross-sectional, randomized convenience survey mailed to US women in 2000, as part of the larger Women’s International Study of Health and Sexuality. Respondents were 952 women (most were married and Caucasian) who comprised 28% of the total identified as potential participants. The response rate was 77%.

Results from hysterectomized (without oophorectomy) and perimenopausal women were not included in this analysis, but will be reported elsewhere. No socioeconomic data were given.

Although the study was funded by Procter&Gamble, it was conducted by an independent, survey-based research group.

3 types of questionnaires were used:

• Overall health status was measured by Short Form-36
  
• Profile of Female Sexual Function
  
• Personal Distress Scale
  

The relationship between sexual desire and frequency of sexual activity also was assessed, as well as relationship satisfaction.

Expert Commentary

The finding that HSDD is substantially higher in young, surgically menopausal women (26%) than in premenopausal women the same age (14%) makes this an important study. Previously, estimates put the prevalence at 20% in the general population. Although it occurs in both sexes, the disorder is more common in women.

Contributing factors include medical problems such as heart disease or any disabling illness. Antihypertensives, antidepressants, and oral contraceptives also may lower sexual desire.

Role of testosterone. Endogenous testosterone levels and sexual function are not clearly linked, but exogenous testosterone—regardless of route of administration—positively affects sexual function after spontaneous or surgically induced menopause.^1,2

Nonmedical contributors. HSDD may be associated with communication issues or power struggles between sex partners. A lack of affection, poor emotional intimacy, or inadequate time alone together may precipitate HSDD, as can a very restrictive upbringing concerning sex, or negative or traumatic sexual experiences.

Depression, fatigue, or excessive stress may also inhibit sexual interest.

Experimental treatments

Treatment depends in part on the duration of the problem and its causes. No drug therapy has been approved for HSDD in women, although testosterone and other therapies are being studied. Psychotherapy is reported to be mildly effective.

Continuous transdermal testosterone (300-μg patch) improved sexual desire, arousal, and orgasm frequency in women after oophorectomy, with no significant side effects.³

A 24-week study⁴ determined that surgically menopausal women (n=283) who receive transdermal testosterone 300 μg daily along with estrogen experienced 1 additional episode of satisfying sexual activity every 4 weeks, as well as decreased distress and improved desire. Studies are underway to determine whether the findings are clinically significant and to establish longer-term safety and efficacy. The testosterone patch lacks FDA approval.

Don’t forget about prevention

Women who have not undergone premature surgical menopause can help prevent HSDD using these measures:

• Reserving time for nonsexual intimacy such as weekly dating to maintain a closer relationship
  
• “Separating” affection and sex so that affection is not interpreted as an invitation to proceed to intercourse
  
• Increasing communication through books, classes, or reading or watching materials with romantic or sexual content
  
• Reserving time for both talking and sexual intimacy earlier in the evening before exhaustion sets in, to encourage closeness and sexual desire.
  

A This disorder is prevalent in women at all reproductive stages. Younger, surgically postmenopausal women were at greatest risk among 4 demographic groups analyzed (TABLE). Prevalence ranged from 26% in surgically postmenopausal women aged 20 to 49, to 9% in naturally postmenopausal women.

Hypoactive sexual desire disorder (HSDD) should be recognized as an important quality-of-life issue, particularly for those at increased risk, this report concluded. WISHeS is the first study to report the prevalence of HSDD in US women using well-validated questionnaires, and to assess sexual, relationship, and quality-of-life correlates. Psychosocial distress and significant decrements in general health status, including aspects of mental and physical health, were linked to HSDD.

TABLE

Hypoactive sexual desire disorder rates in US women

AGE 20–49	%
Premenopausal	14
Surgically menopausal	26
AGE 50–70
Naturally postmenopausal	9
Surgically postmenopausal	14

What makes hypoactive sexual desire a disorder?

HSDD is diminished desire for sexual activity, including sexual fantasies. It is considered a disorder only if it causes marked distress for the patient or serious interpersonal relationship problems.

HSDD is associated with these problems:

• greater emotional and psychological distress,
  
• lowered sexual and partner satisfaction, and
  
• diminished general health, both mental and physical.
  

Details of the study

The findings were derived from a cross-sectional, randomized convenience survey mailed to US women in 2000, as part of the larger Women’s International Study of Health and Sexuality. Respondents were 952 women (most were married and Caucasian) who comprised 28% of the total identified as potential participants. The response rate was 77%.

Results from hysterectomized (without oophorectomy) and perimenopausal women were not included in this analysis, but will be reported elsewhere. No socioeconomic data were given.

Although the study was funded by Procter&Gamble, it was conducted by an independent, survey-based research group.

3 types of questionnaires were used:

• Overall health status was measured by Short Form-36
  
• Profile of Female Sexual Function
  
• Personal Distress Scale
  

The relationship between sexual desire and frequency of sexual activity also was assessed, as well as relationship satisfaction.

Expert Commentary

The finding that HSDD is substantially higher in young, surgically menopausal women (26%) than in premenopausal women the same age (14%) makes this an important study. Previously, estimates put the prevalence at 20% in the general population. Although it occurs in both sexes, the disorder is more common in women.

Contributing factors include medical problems such as heart disease or any disabling illness. Antihypertensives, antidepressants, and oral contraceptives also may lower sexual desire.

Role of testosterone. Endogenous testosterone levels and sexual function are not clearly linked, but exogenous testosterone—regardless of route of administration—positively affects sexual function after spontaneous or surgically induced menopause.^1,2

Nonmedical contributors. HSDD may be associated with communication issues or power struggles between sex partners. A lack of affection, poor emotional intimacy, or inadequate time alone together may precipitate HSDD, as can a very restrictive upbringing concerning sex, or negative or traumatic sexual experiences.

Depression, fatigue, or excessive stress may also inhibit sexual interest.

Experimental treatments

Treatment depends in part on the duration of the problem and its causes. No drug therapy has been approved for HSDD in women, although testosterone and other therapies are being studied. Psychotherapy is reported to be mildly effective.

Continuous transdermal testosterone (300-μg patch) improved sexual desire, arousal, and orgasm frequency in women after oophorectomy, with no significant side effects.³

A 24-week study⁴ determined that surgically menopausal women (n=283) who receive transdermal testosterone 300 μg daily along with estrogen experienced 1 additional episode of satisfying sexual activity every 4 weeks, as well as decreased distress and improved desire. Studies are underway to determine whether the findings are clinically significant and to establish longer-term safety and efficacy. The testosterone patch lacks FDA approval.

Don’t forget about prevention

Women who have not undergone premature surgical menopause can help prevent HSDD using these measures:

• Reserving time for nonsexual intimacy such as weekly dating to maintain a closer relationship
  
• “Separating” affection and sex so that affection is not interpreted as an invitation to proceed to intercourse
  
• Increasing communication through books, classes, or reading or watching materials with romantic or sexual content
  
• Reserving time for both talking and sexual intimacy earlier in the evening before exhaustion sets in, to encourage closeness and sexual desire.
  

A This disorder is prevalent in women at all reproductive stages. Younger, surgically postmenopausal women were at greatest risk among 4 demographic groups analyzed (TABLE). Prevalence ranged from 26% in surgically postmenopausal women aged 20 to 49, to 9% in naturally postmenopausal women.

Hypoactive sexual desire disorder (HSDD) should be recognized as an important quality-of-life issue, particularly for those at increased risk, this report concluded. WISHeS is the first study to report the prevalence of HSDD in US women using well-validated questionnaires, and to assess sexual, relationship, and quality-of-life correlates. Psychosocial distress and significant decrements in general health status, including aspects of mental and physical health, were linked to HSDD.

TABLE

Hypoactive sexual desire disorder rates in US women

AGE 20–49	%
Premenopausal	14
Surgically menopausal	26
AGE 50–70
Naturally postmenopausal	9
Surgically postmenopausal	14

What makes hypoactive sexual desire a disorder?

HSDD is diminished desire for sexual activity, including sexual fantasies. It is considered a disorder only if it causes marked distress for the patient or serious interpersonal relationship problems.

HSDD is associated with these problems:

• greater emotional and psychological distress,
  
• lowered sexual and partner satisfaction, and
  
• diminished general health, both mental and physical.
  

Details of the study

The findings were derived from a cross-sectional, randomized convenience survey mailed to US women in 2000, as part of the larger Women’s International Study of Health and Sexuality. Respondents were 952 women (most were married and Caucasian) who comprised 28% of the total identified as potential participants. The response rate was 77%.

Results from hysterectomized (without oophorectomy) and perimenopausal women were not included in this analysis, but will be reported elsewhere. No socioeconomic data were given.

Although the study was funded by Procter&Gamble, it was conducted by an independent, survey-based research group.

3 types of questionnaires were used:

• Overall health status was measured by Short Form-36
  
• Profile of Female Sexual Function
  
• Personal Distress Scale
  

The relationship between sexual desire and frequency of sexual activity also was assessed, as well as relationship satisfaction.

Expert Commentary

The finding that HSDD is substantially higher in young, surgically menopausal women (26%) than in premenopausal women the same age (14%) makes this an important study. Previously, estimates put the prevalence at 20% in the general population. Although it occurs in both sexes, the disorder is more common in women.

Contributing factors include medical problems such as heart disease or any disabling illness. Antihypertensives, antidepressants, and oral contraceptives also may lower sexual desire.

Role of testosterone. Endogenous testosterone levels and sexual function are not clearly linked, but exogenous testosterone—regardless of route of administration—positively affects sexual function after spontaneous or surgically induced menopause.^1,2

Nonmedical contributors. HSDD may be associated with communication issues or power struggles between sex partners. A lack of affection, poor emotional intimacy, or inadequate time alone together may precipitate HSDD, as can a very restrictive upbringing concerning sex, or negative or traumatic sexual experiences.

Depression, fatigue, or excessive stress may also inhibit sexual interest.

Experimental treatments

Treatment depends in part on the duration of the problem and its causes. No drug therapy has been approved for HSDD in women, although testosterone and other therapies are being studied. Psychotherapy is reported to be mildly effective.

Continuous transdermal testosterone (300-μg patch) improved sexual desire, arousal, and orgasm frequency in women after oophorectomy, with no significant side effects.³

A 24-week study⁴ determined that surgically menopausal women (n=283) who receive transdermal testosterone 300 μg daily along with estrogen experienced 1 additional episode of satisfying sexual activity every 4 weeks, as well as decreased distress and improved desire. Studies are underway to determine whether the findings are clinically significant and to establish longer-term safety and efficacy. The testosterone patch lacks FDA approval.

Don’t forget about prevention

Women who have not undergone premature surgical menopause can help prevent HSDD using these measures:

• Reserving time for nonsexual intimacy such as weekly dating to maintain a closer relationship
  
• “Separating” affection and sex so that affection is not interpreted as an invitation to proceed to intercourse
  
• Increasing communication through books, classes, or reading or watching materials with romantic or sexual content
  
• Reserving time for both talking and sexual intimacy earlier in the evening before exhaustion sets in, to encourage closeness and sexual desire.