Hypoactive sexual desire disorder ( HSDD ) or obstructed sexual desire ( ISD ) is considered sexual dysfunction and is characterized as a lack of or the absence of sexual fantasies and desire for sexual activity, as assessed by a doctor. For this to be regarded as a nuisance, it must cause marked difficulties or interpersonal difficulties and is not better accounted for by other mental disorders, drugs (legal or illegal), some other medical conditions, or asexuality. A person with an ISD will not start, or respond to their partner's desire for, sexual activity.
There are various subtypes. HSDD can be general (generally lacking sexual desire) or situational (still having sexual desire, but no sexual desire for the current partner), and may be obtained (HSDD begins after normal sexual functioning period) or lifetime (the person has always do not have/low sexual desire.)
HSDD has accumulated a lot of criticism, especially by asexual activists. They pointed out that HSDD placed asexuality in the same homosexuality position from 1974 to 1987. DSM at that time recognized 'ego-distonic homosexuality' as a disorder, defined as sexual attraction in the same gender that caused significant suffering. DSM itself officially recognized this as unnecessary pathological homosexuality and removed it as a nuisance in 1987.
DSM-IV Disorders. In DSM-5, it is divided into male hypoactive sexual desire dysfunction and female sexual interest/arousal . It was first included in the DSM-III by name inhibiting the disruption of sexual desire, but the name was changed in DSM-III-R. Other terms used to describe phenomena include sexual aversion and sexual apathy. More informal or everyday terms are frigidity and frigidness .
Video Hypoactive sexual desire disorder
Cause
Low sexual desire alone is not equivalent to HSDD because of the requirement in HSDD that low sexual desire causes marked difficulty and interpersonal difficulty and because of the need that low desire is not better recorded by other disorders in DSM or by general health problems. It is therefore difficult to say precisely what causes HSDD. It is easier to describe, on the contrary, some of the causes of low sexual desire.
In men, although theoretically there are more types of HSDD/low sexual desire, usually men are only diagnosed with one of three subtypes.
- Lifetime/general: The man has little or no desire for sexual stimulation (with spouse or alone) and never does.
- Acquired/general: This man previously had sexual attraction to his current partner, but was less interested in sexual activity, partnering or alone.
- Acquired/situational: The man was previously sexually attracted to his current partner but now has no sexual attraction to the couple but has a passion for sexual stimulation (ie alone or with someone other than his current spouse).
Although it is sometimes difficult to distinguish between these types, they do not always have the same cause. The cause of lifetime/general HSDD is unknown. In the case of low acquired/generalized sexual desire, possible causes include various medical/health problems, psychiatric problems, low testosterone levels or high prolactin levels. One theory shows that sexual desire is controlled by a balance between inhibiting factors and stimuli. This is thought to be expressed through neurotransmitters in a selective area of ​​the brain. Decreased sexual desire may be due to an imbalance between neurotransmitters with excitatory activity such as dopamine and norepinephrine and neurotransmitters with inhibitory activity, such as serotonin. The New York-based "New View Campaign" organization has expressed skepticism about too much emphasis on neurotransmitter explanations because the emphasis on the explanation has been made largely by the "education" effort funded by Boehringer-Ingelheim while trying to get the FDA. to approve drugs that affect neurotransmitters for treatment for HSDD. Low sexual desire can also be a side effect of various drugs. In the case of acquired/situational HSDD, possible causes include difficulty of intimacy, relationship problems, sexual addiction, and chronic male partner illness. The evidence for this is somewhat questionable. Some claims of low sexual desire are based on empirical evidence. However, some are based only on clinical observations. In many cases, the cause of HSDD is unknown.
There are several factors that are believed to be the cause of HSDD in women. Like men, various medical problems, psychiatric problems (such as mood disorders), or an increase in the amount of prolactin can cause HSDD. Other hormones are also believed to be involved. In addition, factors such as relationship problems or stress are believed to be a possible cause of decreased sexual desire in women. According to a recent study that looked at affective responses and captured the attention of sexual stimulation in women with and without HSDD, women with HSDD did not appear to have a negative relationship to sexual stimulation, but rather a weaker positive association than women without HSDD.
Maps Hypoactive sexual desire disorder
Diagnosis
In DSM-5, male hypoactive sexual desire disorder is characterized by "persistent or repetitive lack (or absence) of sexual/erotic thoughts or fantasies and desire for sexual activity", as assessed by a physician with due consideration for the patient's age and cultural context. Female sexual arousal is defined as "lack of, or significantly reduced, passion/sexual arousal", which manifests as at least three of the following symptoms: no or little interest in sexual activity, no or some sexual thoughts, none or some attempt to initiate sexual activity or respond to partner initiation, no or little sexual pleasure/delight in 75-100% sexual experience, no or little sexual interest in internal or external erosive stimulation, and no or some genital/nongenital sensation in 75 -100% sexual experience.
For both diagnoses, symptoms should persist for at least six months, causing clinically significant distress, and not better explained by other conditions. Just having a lower desire than a person's partner is not enough for diagnosis. Identify yourself from a lifetime lack of lifelong desire because asexuality prevents diagnosis.
Treatment
Counseling
HSDD, like many sexual dysfunctions, is something that people treat in the context of relationships. Theoretically, a person can be diagnosed with, and treated for, HSDD without being in a relationship. However, relationship status is the most predictive accounting factor for adversity in women with low and depressed desire required for the diagnosis of HSDD. Therefore, it is common for both partners to engage in therapy. Usually, the therapist tries to discover the psychological or biological causes of HSDD. If HSDD is organically caused, the doctor may try to treat it. If doctors believe it is rooted in psychological problems, they can recommend therapy. Otherwise, treatment is generally more focused on relationship and communication problems, improving communication (verbal and nonverbal), working on non-sexual intimacy, or education on sexuality may all be part of the treatment. Sometimes problems occur because people have unrealistic perceptions of what normal sexuality is and are concerned that they do not compare well, and this is one reason why education can be important. If the doctor thinks that part of the problem is the result of stress, the technique may be recommended to more effectively deal with it. Also, it is important to understand why low-level sexual desire is a problem for relationships because both partners can associate different meanings with sex but do not know it.
In the case of men, therapy may depend on subtype HSDD. Increasing the level of a man's sexual desire with lifetime/general HSDD is not possible. Instead the focus may be on helping couples to adapt. In the case of acquired/general, there is the possibility that there are some biological reasons for that and the doctor may try to overcome them. In a given/situational case, some form of psychotherapy may be used, perhaps with the man himself and perhaps along with his partner.
Medication
Approved
Flibanserin is the first and only drug approved for women for the treatment of HSDD. It was only slightly effective compared with placebo, which has been found to increase the average number of satisfying sexual events per month from 0.5 to 1. Side effects from dizziness, drowsiness, and nausea occur about three to four times more often. Overall improvement is a bit to none.
Off-label
Several studies have shown that antidepressants, bupropion, can improve sexual function in non-depressed women, if they have HSDD. The same is true for anxiolytic, buspirone, which is a 5-HT receptor agonist 1A similar to flibanserin.
Testosterone supplementation is effective in the short term. However, its long-term security is unclear.
Investigational
Bremelanotide (brand name while Rekynda), a melanocortin receptor agonist, has successfully completed phase III clinical trials for the treatment of HSDD. New Drug Applications are expected to be submitted in the second half of 2017.
History
In early versions of DSM, there were only two registered sexual dysfunctions: frigidity (for women) and impotence (for men).
In 1970, Masters and Johnson published their book Human Sexual Infectivities describing sexual dysfunction, although this only included dysfunction related to genital function such as premature ejaculation and impotence for men, and anorgasmia and vaginismus for women. Prior to the Masters and Johnson research, female orgasm was assumed by some to be from the vagina, not the clitoris, stimulation. Consequently, feminists argue that "frigidity" is "defined by men as the failure of women to experience vaginal orgasm".
Following this book, sex therapy increased throughout the 1970s. Reports from sex therapists on people with low sexual desire were reported at least since 1972, but labeling this as a special disorder did not occur until 1977. In that year, sex therapists Helen Singer Kaplan and Harold Lief independently proposed each other to create special category for people with low or no sexual desire at all. Lief called it "sexual desire stunted," and Kaplan called it "hypoactive sexual desire". The main motivation for this is that the preceding model for sex therapy assumed a certain level of sexual attraction in one's spouse and that the problem was only caused by abnormal/non functional functioning of the genitals or performance anxiety but the therapy based on the problem was ineffective for people who were not sexually wants her partner. The following year, 1978, Lief and Kaplan jointly made a proposal to the APA task force for the sexual disorder for DSM III, where Kaplan and Lief were both members. Diagnosis of delayed sexual hashing (ISD) was added to DSM when the 3rd edition was published in 1980.
To understand this diagnosis, it is important to recognize the social context in which it was created. In some cultures, low sexual desire can be considered normal and high sexual desires are problematic. For example, sexual desire may be lower in East Asian populations than in the Euro-Canada/American population. In other cultures, this may be reversed. Some cultures strive to contain sexual desire. Others try to awaken it. The concept of "normal" sexual desire levels is culturally dependent and seldom neutral in value. In the 1970s, there was a strong cultural message that sex was good for you and "the more the better". In this context, people who are accustomed to not interested in sex, which in the past may not see this as a problem, are more likely to feel that this is a situation that needs to be improved. They may feel alienated by the dominant messages about sexuality and more and more people go to sex therapists who complain of low sexual desire. It is in this context that the diagnosis of ISD was created.
In the revised DSM-III, published in 1987 (DSM-III-R), ISD is divided into two categories: Hypoactive Sexual Rise Desertion and Sexual Limit Trouble (SAD). The first is the lack of interest in sex and the last is the reluctance of phobias against sex. In addition to this division, one of the reasons for change is that the committee involved in revising psychosexual disorder for DSM-III-R thinking that the term "inhibited" suggests a psychodynamic cause (ie that conditions for sexual desire are present, but people, for some reason, inhibit their own sexual interest.) The term "hypoactive sexual desire" is more awkward, but more neutral with respect to the cause. DSM-III-R estimates that about 20% of the population has HSDD. In DSM-IV (1994), the criterion that diagnosis requires "marked difficulty or interpersonal difficulty" is added.
The DSM-5, published in 2013, divides HSDD into male hypoactive sexual desire disruption and female sexual passion/passionate discomfort . The difference was made because men reported more intense and frequent sexual desires than women. According to Lori Brotto, this classification is desirable compared to the DSM-IV classification system because: (1) it reflects the finding that desire and passion tend to overlap (2) it distinguishes between women who lack desire before the onset of activity, but who receive initiation and/or initiation sexual activity for reasons other than desire, and women who have never experienced sexual arousal (3) required variability in sexual desire. In addition, the criteria of the 6 symptoms present for diagnosis help guard against pathologization of adaptive degradation in desire.
Criticism
General
HSDD, as defined by DSM is currently under criticism of the social function of diagnosis.
- HSDD can be seen as part of the history of medicalization of sexuality by the medical profession to define normal sexuality. It has also been examined in the "broader framework of historical interest in the problematization of sexual desire".
- HSDD has been criticized for the pathologically normal variations in sexuality because the parameters of normality are unclear. This lack of clarity is partly due to the fact that the terms "persistent" and "repetitive" do not have a clear operational definition.
- HSDD can work to model asexual, although their lack of sexual desire may not be maladaptive. As such, some members of the asexual community lobby the mental health community working on the DSM-5 to regard asexuality as a legitimate sexual orientation rather than a mental disorder.
Other criticisms are more focused on scientific and clinical problems.
- HSDD is a diverse group of conditions with many causes that serve as little more than a starting place for physicians to assess people.
- The requirement that low sexual desire causes interpersonal difficulties or difficulties is criticized. It has been claimed that it is not clinically useful because if it does not cause problems, the person will not seek a doctor. One can claim that this criterion (for all sexual dysfunctions, including HSDD) decreases the scientific validity of the diagnosis or is covering up the lack of data about what constitutes normal sexual function.
- The requirements of distress are also criticized because the term "distress" has no clear definition.
DSM-IV Criteria
Prior to the publication of DSM-5, the DSM-IV criteria were criticized for several reasons. It is recommended that the duration criteria should be added because the lack of interest in sex during the past month is significantly more common than the lack of interest lasting six months. Similarly, frequency criteria (ie, low desire symptoms present in 75% or more of sexual encounters) have been suggested.
Source of the article : Wikipedia
0 Comments