Hypoactive Sexual Desire Disorder: 'I'm Not In the Mood'

Hypoactive sexual desire disorder (HSDD) is the most common form of female sexual dissatisfaction (FSD) and occurs when there is a persistent lack of desire or absence of sexual fantasies. In other words, you're rarely in the mood; you neither initiate sex nor seek stimulation.

Lack of desire often occurs as a result of relationship conflicts, say Drs. Jennifer and Laura Berman, two of the nation's top experts on sexual health for women.

"Communications problems, anger, a lack of trust, a lack of connection and a lack of intimacy can all adversely affect a woman's sexual response and interest," they write in their book: For Women Only: A Revolutionary Guide to Overcoming Sexual Dysfunction and Reclaiming Your Sex Life.

If this sounds like you, counseling and therapy with your partner is probably your No. 1 treatment option to overcome HSDD, the sisters say.

Medical Causes of HSDD

Obviously, lifestyle factors also influence the desire for sex. A single working mom who is overwhelmed by family needs may feel too exhausted to relax, kick back and fantasize about sex - let alone engage in it! However, sometimes a medical condition is the underlying cause of low libido, including:

• Medication Use: Many commonly prescribed drugs, such as antihypertensives, antidepressants and birth control pills, interfere with sex drive, arousal and orgasm by affecting the balance of sexual hormones and the transmission of chemical messengers. For instance, antidepressants known as selective serotonin reuptake inhibitors combat depression by increasing the production of serotonin in the brain. Unfortunately, serotonin dampens sexual desire.

• Menopause: The onset of menopause, either surgical or natural, is characterized by a gradual decline of the hormones estrogen, progesterone and testosterone. Reduced testosterone levels, in particular, say the Bermans, can lead to a "sudden or gradual" decline in libido. Ironically, the conventional hormone replacement regime of estrogen and progesterone given to relieve menopausal symptoms can make matters worse, because estrogen increases a protein (called steroid hormone-binding globulin) in the blood that binds to testosterone, causing it to become less available to the body.

• Depression: A common symptom of depression is a diminished sex drive, which, in turn, can exacerbate depression. Studies indicate that 12 percent of all women will experience clinical depression at some point in their lives. As mentioned, one of the side effects of the popular antidepressants Prozac, Paxil and Zoloft is loss of libido. Dysthymia is a lower-grade form of depression that is not easily diagnosed because you can function with it, note the Bermans. A woman with dysthymia may feel isolated and overwhelmed and withdraw from sex and social activities.

Overcoming Libido Loss

If you're suffering from loss of libido and think there is a medical basis for your problem, here are some solutions to consider:

• Talk to your doctor about testosterone, especially if you have had your ovaries removed, are taking estrogen or under severe stress. Get your testosterone level evaluated and if it is below 20 nanograms per deciliter, consider starting testosterone therapy. "To us, testosterone is so central to a woman's sexual function, that no lover and no amount of sexual stimulation can make up for its absence," write the Bermans, who report enormous success in treating low-libido patients with supplemental testosterone. Testosterone to treat FSD has not been approved by the FDA, notes Dr. Jennifer Berman, so you'll need to find a physician open to prescribing it to treat lack of sexual desire. If you are already on hormone replacement therapy for menopausal symptoms, ask your doctor to add testosterone to your regimen.

• Switch to medications known to have less effect on sexual function or lower dosages. The antidepressants Prozac, Zoloft and Paxil, of which women are major consumers, cause loss of libido in as many as 60 percent of patients. "We generally switch to one that has less of a sexual side effect," like Celexa, Wellbutrin, BuSpar, Serzone or Effexor, says Jennifer.

• The little blue pill may help jump-start your sex life as long as "you have the desire to engage in sex and have been stimulated enough for it to take effect," say the Bermans. It's especially helpful if your lack of desire is related to hysterectomy or menopause. Physicians aren't exactly sure how Viagra helps rekindle lust - the Bermans are investigating how it works in their clinic - but they know it helps women achieve arousal, which is the phase that comes after desire, by increasing blood flow to the vagina, clitoris and labia.