What Is HSDD?
Defining hypoactive sexual desire disorder

What is hypoactive sexual desire disorder (HSDD)?

According to an evidence-based consensus statement developed by leading professional sexual medicine societies*1

HSDD is the persistent or recurrent deficiency or absence of sexual thoughts, fantasies, and/or desire for sexual activity.1 It manifests as any of the following for a minimum of 6 months2:

  • Lack of motivation for sexual activity as manifested by either:
    • Decreased or absent spontaneous desire (sexual thoughts or fantasies)
    • Decreased or absent responsive desire to erotic cues and stimulation or inability to maintain desire or interest through sexual activity
  • Loss of desire to initiate or participate in sexual activity, including behavioral responses such as avoidance of situations that could lead to sexual activity, that is not secondary to sexual pain disorders
  • AND is combined with clinically significant personal distress that includes feelings of frustration, grief, incompetence, loss, sadness, sorrow, or worry

*Developed and accepted for use by the International Society for the Study of Women’s Sexual Health (ISSWSH) and members of other participating societies.2

How common is HSDD?

HSDD is the most prevalent female sexual dysfunction (FSD). In addition to HSDD, FSD includes diminished sexual arousal and orgasmic difficulties.3

How is HSDD classified?

Different classifications of HSDD are based on several factors, comprised of onset, context, and etiology4:


the problem developed after a period of normal sexual functioning

the problem has been present since the onset of sexual functioning


the problem is not limited to certain types of stimulation, situations, or partners

the problem is limited to certain types of stimulation, situations, or partners


only psychological factors are associated with the onset, severity, exacerbation, or maintenance of the problem

psychological factors and/or medical conditions/substance use can be associated with the onset, severity, exacerbation, or maintenance of the problem

HSDD has been a recognized medical condition for approximately 4 decades5

1966 Human sexual response cycle was first conceived by Masters and Johnson

1977, 1979 Kaplan and Lief independently proposed the diagnosis of inhibited sexual desire

  • Masters and Johnson’s model was expanded to recognize the important role of sexual desire
  • The resulting triphasic model of desire, excitement, and orgasm served as the basis for how sexual disorders were categorized in the DSM

1980 The DSM-III™ first categorized sexual disorders

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Female sexual dysfunction is a spectrum of disorders

Sharon J. Parish, MD, Weill Cornell Medical College, provides an introduction to Female Sexual Dysfunction (FSD).
Sharon J. Parish, MD, IF, NCMP
Weill Cornell Medical College

Dr. Parish is a consultant for AMAG Pharmaceuticals, Inc. and Palatin Technologies, Inc.

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References: 1. McCabe MP, Sharlip ID, Atalla E, et al. Definitions of sexual dysfunctions in women and men: a consensus statement from the Fourth International Consultation on Sexual Medicine 2015. J Sex Med. 2016;13(2):135-143. 2. Parish SJ, Goldstein AT, Goldstein SW, et al. Toward a more evidence‐based nosology and nomenclature for female sexual dysfunctions—part II. J Sex Med. 2016;13(12):1888-1906. 3. Shifren JL, Monz BU, Russo PA, Segreti A, Johannes CB. Sexual problems and distress in United States women: prevalence and correlates. Obstet Gynecol. 2008;112(5):970‐978. 4. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994. 5. Brotto LA. The DSM diagnostic criteria for hypoactive sexual desire disorder in women. Arch Sex Behav. 2010;39(2):221-239.

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