What is HSDD?
Hypoactive sexual desire disorder can affect all women of sexually active age including premenopausal to menopausal women. The broadened definition of hypoactive sexual desire disorder (HSDD) may include any of the following: lack of motivation for sexual activity as manifested by either reduced or absent sexual thoughts or fantasies or reduced or absent responsive desire to erotic cues and stimulation or inability to maintain desire or interest through sexual activity or; loss of desire to initiate or participate in sexual activity, including behavioral responses such as avoidance of situations that could lead to sexual activity. This does not apply when the decreased desire is caused by sexual pain disorders and when combined with clinically significant personal distress that includes frustration, grief, incompetence, loss, sadness, sorry, or worry. The following factors can contribute to HSDD in women.
The mind is very powerful and can provoke changes in mood or attitude without some people even noticing that they are acting or feeling differently. Depression is a serious mental illness that can lead to various problems throughout the entire body. Women suffering from depression may lose interest in activities that were once pleasurable including sexual desire. There may be a dissatisfaction with life, sex, marriage, or partner. The feelings of dissatisfaction with the partner may arise from many internal negative feelings. Avoiding situations that can lead to intimacy can occur and may lead to problems with the partner. Women with an impaired self-body image or a decrease in self-confidence may feel insecure which can lead to discomfort during physical contact. This can also lead to avoidance and problems with your partner. Group therapy with a psychologist and your partner may help in these situations. Often times a few sessions are enough to improve sexual desire.
For years hormones have been studied and analyzed for increasing or decreasing sexual desire. A decrease in testosterone and estradiol levels are associated with a decrease in sexual desire. These hormones are normally elevated in the periovulatory period of the menstrual cycle and, therefore, an increase in sexual desire around this time is expected. A decrease in these hormones may be another cause for a hypoactive sexual desire in premenopausal women as well as in menopausal women. Progesterone, on the other hand, is associated with a decrease in sexual desire, therefore, an increase in this hormone can lead to a decrease in sexual desire and vice versa. A gynecologist or family doctor can assist with hormone analysis and adjusting.
Sexual desire is regulated in the prefrontal cortex, locus coeruleus, medial preoptic area, paraventricular nucleus, and reward and attention-processing centers of the ventral tegmental area and the nucleus accumbens. Sexual excitation involves the actions of brain dopamine, melanocortin, oxytocin, vasopressin, and norepinephrine. Sexual inhibition involves brain opioid, serotonin, and endocannabinoid systems. These inhibitory systems blunt the ability of excitatory systems to be activated. Drugs that decrease brain dopamine levels or stimulate the sexual inhibition areas, like serotonin and opioids, will decrease sexual desire. Conversely, increasing hypothalamic and mesolimbic dopamine levels or decreasing serotonin release in the prefrontal cortex can stimulate sexual desire.
Pain during intercourse is also a deterrent for many women. The pain can be due to several causes, however, one of the most common reasons for pain is a lack of sufficient lubrication. This can cause an uncomfortable tearing, ripping, or even burning feeling during intercourse and can often be remedied with precoital stimulation or use of adequate lubricating gels. Other causes include infections, cancer, endometriosis or adenomyosis, estrogen deficiency, pelvic masses, bladder infection, psychological pain, therefore, being able to pinpoint the area of the pain during intercourse can help your doctor with the diagnosis.
There are also physical conditions that can influence sexual desire. Poor health, thyroid disease, and urinary incontinence may contribute to hypoactive sexual desire disorder. Preventing and or treating these require routine check-ups and treating underlying health conditions before problems can arise.
There are many possible reasons for a decreased sexual desire in women. Some can be easily remedied while others may require several visits to the doctor. Flibanserin is an FDA approved drug that functions by selectively activate stimulatory pathways or reduce inhibitory pathways for the treatment of HSDD. Consult your doctor if you are experiencing sexual discomfort.
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