Hypoactive sexual desire disorder (HSDD) is a fairly well known disorder that causes disinterest in sex in what would ordinarily be situations where arousal is common. It also may cause lack of normal fantasizing, total disgust by normal sexual activity, or panic or depression when in sexual situations. The condition occurs in both women and men, and may be present without any underlying and identifiable cause, or it can have clear physiological causes. In many cases, HSDD is most problematic when a person is in relationship with someone else because unmet expectations for intercourse in a close relationship like a marriage can lead to marital trouble.
When it occurs without underlying physical symptoms, it is called primary hypoactive sexual desire disorder, and may be most difficult to treat. Other times, physical attributes or conditions contribute to it and these can include immature sexual development, pain occurring in the vagina during intercourse, little to no feeling or sensation in the male organ, or tumors in the pituitary gland. HSDD should be seen as distinct from other causes of sexual disinterest like severe depression or medications often taken for depression that can dramatically reduce libido.
There are peculiarities about hypoactive sexual desire disorder worth noting. Sometimes only the desire is absent for the person. They cannot, for example, become aroused specifically by their partner. This is most challenging, and though occasionally sex therapy might be of assistance, it isn’t always. Such couples may either decide to live without intercourse or they may decide not to continue a marriage, particularly if either spouse finds it necessary to go outside the marriage for sexual gratification. It’s not always the case that HSDD is person-specific, and some people are unable to be aroused under any circumstances.
As stated, hypoactive sexual desire disorder tends to be most problematic when a person is in relationship with someone else, where there is a normal expectation of intercourse. A person with HSDD may have the physical ability to function through intercourse but the experience can be aversive, traumatic, painful or boring. Level of sexual activity tends to decline in such relationships to the point where it may not exist at all.
A physiologically based explanation for hypoactive sexual desire disorder is often met with the most favorable outcome, since many physiological causes have treatment. In primary HSDD, the condition is more challenging to treat. Psychotherapy and sex therapy may be attempted, along with medications that could increase libido or dull anxiety, like some of the antidepressants that don’t cause sexual side effects. Cure rate is not excellent, and some people find the only way they cure the problem is changing sexual partners, while others find the problem remains unaddressed. This condition and others like it strongly stress the continuing need for better understanding of the psychological, social, and biological factors that influence sexual interest and arousal.