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Sexual desire disorders have the lowest success treatment rate among sexual disorders Etiologic complexity, the importance of relationship issues, intimacy frustration, or low motivation to improve sexual relations with the current partner, may explain why the response to treatment is generally so disappointing, particularly in unmotivated patients Better results may be possible in highly motivated patients, when hormonal loss is the leading etiology (as in surgical menopause) and appropriate hormonal therapy (HT) may restore libido and a satisfactory sexual response Based on the etiologic diagnosis, biologic, psychogenic/relational, or combined treatment by the healthcare provider may be required Referral to, or collaboration with specialists may be indicated: HT, systemic or topical, with or without androgens Hypoprolactinemic drug, if high prolactin was diagnosed Thyroxine, if hypothyroidism was diagnosed Low-dose antidepressant, if a mood disorder is a co-factor (bupropion seems to offer better results) [13] Better glycemic control, in diabetic women Checking and modi cation of drugs potentially causing iatrogenic loss of libido, such as levosulpiride, because of its hyperprolactinemic effect
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The clinician should try to become comfortable with these quite intimate questions, choosing ways of asking them that he/she feels at ease with With time, proper training and familiarity with this issue, this clinical history recording will be increasingly rewarding in terms of diagnostic accuracy, patient satisfaction, and improvement of clinician patient relationship
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If the clinical history suggests a possible biologic etiology, the clinician should assess the following:
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Sexual Desire Disorders in Women Lifestyle improvement: smoking and alcohol reduction, weight control and regular physical exercise to improve body image and mood, better diet, sleep improvement to restore vital energy Appropriate counseling and medical support in all patients suffering from a persistent low sexual desire after a serious or chronic illness Treatment of any FSD co-morbidity, particularly with aversion disorder, vaginismus and/or dyspareunia, with accurate address of pelvic- oor related issues, or orgasmic disorder that would maintain low or absent sexual motivation to intimacy unless appropriately treated Optimal referral includes: the uroandrologist, when the loss of desire appears to be secondary to a male sexual problem; the couple therapist when the desire disorder re ects relational problems; the psychiatrist: (1) if low desire re ects development traumas such as child abuse or parental loss Women who have con ict with intimacy or about sexuality should be referred for psychotherapy; (2) if the woman is found to have an underlying psychiatric disorder such as major depressive disorder or generalized anxiety disorder
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1 Basson R, Althof S, Davis S, Fugl-Meyer K, Goldstein I, Leiblum S, Meston C, Rosen R, Wagner G Summary of the recommendations of sexual dysfunction in women J Sex Med 2004;1:24 39 2 Laumann EO, Paik A, Rosen RC Sexual dysfunction in the United States: prevalence and predictors JAMA 1999;281:537 544 [published erratum appears in JAMA 1999;281(13):1174] [see comments]
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3 Dennerstein L, Koochaki P, Barton I, Graziottin A Hypoactive sexual desire disorder in menopausal women: a survey of western European women J Sex Med 2006;3:212 222 4 Hayes R, Dennerstein L The impact of aging on sexual function and sexual dysfunction in women: a review of population-based studies J Sex Med 2005;2:317 330 5 Panksepp J Affective Neuroscience: The Foundations of Human and Animal Emotions New York: Oxford University Press, 1998 6 Dennerstein L, Burrows GD, Hyman GJ, Sharpe K Hormones and sexuality: effects of estrogen and progestogen Obstet Gynecol 1980;56:316 322 7 Dennerstein L, Randolph J, Taffe J, Dudley E, Burger H Hormones, mood, sexuality and the menopausal transition Fertil Steril 2002;77(suppl 4):S42 S48 8 Dennerstein L, Lehert P, Burger H The relative effects of hormones and relationship factors on sexual functioning of women through the natural menopausal transition Fertil Steril 2005;84:174 180 9 Dennerstein L, Lehert P Modeling mid-aged women s sexual functioning: a prospective, population-based study J Sex Marital Ther 2004;30:173 183 10 Wallen K Sex and context: hormones and primate sexual motivation Horm Behav 2001;40:339 357 11 Lobo RA Treatment of the Postmenopausal Woman: Basic and Clinical Aspects New York: Lippincott Williams & Wilkins, 1999 12 Graziottin A Libido: the biologic scenario Maturitas 2000;34(suppl 1):S9 S16 13 Segraves RT, Balon R Sexual Pharmacology Fast Facts New York: Norton & Co, 2003 14 Dennerstein L, Lehert P, Burger H, Guthrie J Sexuality Am J Med 2005;118(12B):59S 63S 15 Dennerstein L, Dudley E, Burger H Are changes in sexual functioning during midlife due to aging or menopause Fertil Steril 2001;76(3):456 460
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