Circuits of sexual desire in hypoactive sexual desire disorder.

What Is HSDD? For both patients and health care providers, HSDD probably should mean “Having the Sexual Dysfunction Discussion” to diagnose and treat distressful conditions,1 but it really stands for Hypoactive Sexual Desire Disorder. The DSM-IV defines it as the persistent or recurring deficiency (or absence) of sexual fantasies or thoughts or desire for sexual activity associated with personal distress.2 Although surveys suggest that 31% of men and 43% of women experience some sort of sexual dysfunction1,3 (men usually erectile dysfunction and women usually lack of desire),4 both genders experience HSDD. HSDD is the subject of much debate and even controversy, ranging from the gender equality angle that women’s sexual problems are finally receiving the same attention as men’s to the accusation that HSDD is really a form of corporate disease-mongering and a diabolical conspiracy by Pharma to invent a disorder that doesn’t really exist in order to sell dangerous, expensive drugs that don’t really work and thereby exploit unsuspecting women.5 The truth is probably somewhere in between. Certainly, women who have lost interest in their partner but want to have sex with the guy next door do not have HSDD, but a relationship issue. None of this debate should take away from the prospect of helping those women (and men) with distressful problems of reduced sex drive, decreased libido, and a reduced number of satisfying sexual events due to a dysfunctioning reward system. Treatments for HSDD are discussed in the next Brainstorms.6