ICD-10 Code: F52.0
Male hypoactive sexual desire disorder is part of a cluster of diagnoses called the sexual dysfunctions. Sexual dysfunctions are a group of psychiatric conditions that include:
Sexual dysfunctions are characterized by a significant impairment in a person's ability to respond sexually or to experience sexual pleasure. This can refer to an inability to perform or reach an orgasm, painful sexual intercourse, a strong repulsion of sexual activity, or an exaggerated sexual response cycle or sexual interest. An individual may have several sexual dysfunctions at the same time.
Biology, Psychology, and Sexual Function
Several factors can disrupt sexual functioning. Medical conditions such as multiple sclerosis, spinal cord injury or other nerve damage, diabetes, endocrine (hormonal) disorders, and prostatitis can all lead to problems of sexual interest or sexual capacity. Certain medications, such as selective serotonin reuptake inhibitors (SSRIs), may have sexual side effects. Some age-related vascular, nerve-related, and hormonal changes can also adversely affect sexual functioning. It is important to note that when sexual dysfunctions can be primarily attributed to one or more of these biological factors, it should not be diagnosed as a psychiatric disorder, and treatment should target the underlying medical problem. However, in many cases, medical concerns can contribute to a sexual problem, though not necessarily be the primary cause of the problem. In such cases, a psychiatric diagnosis may be appropriate.
Other psychiatric disorders can adversely affect sexual function. As one example, Major Depressive Disorder may be characterized by decreased interest in all or almost all of one's usual activities. Sexual interest, therefore, may be diminished. In such cases, a separate diagnosis of a sexual dysfunction is not warranted. However, as was the case with medical conditions, other psychiatric disorders can contribute to a sexual problem, though not necessarily be the primary cause of the problem. In such cases, a diagnosis of a sexual dysfunction may be appropriate.
Several psychological issues, even in the absence of a diagnosable psychiatric disorder, can contribute to sexual dysfunction. Negative body image may lead to feelings of anxiety around sexuality, inhibiting desire or capacity. Performance anxiety may similarly lead to problems of sexual function. Stressors, such as work or family concerns, may preoccupy the individual, affecting sexual interest or performance. A history of sexual trauma or other negative historical events may create negative associations with sexuality, thus undermining function. In such cases, a diagnosis of a sexual dysfunction is usually warranted.
Relationship factors can also contribute to problems of sexual functioning. At a purely physical level, often an individual's sexual concerns stem not from a problem within the individual, but from a lack of appropriate sexual stimulation from his or her partner. At an interpersonal level, some couples suffer from poor sexual communication, have poor understanding of sexuality, have different desires or preferences for sexual activity, or feel negatively about each other. All of these factors have the potential to adversely affect sexual arousal or performance. Such cases should not be diagnosed as a psychiatric disorder. Again, however, relationship problems can contribute to a sexual problem, though not necessarily be the primary cause of the problem. In such cases, a diagnosis of a sexual dysfunction may be appropriate.
The etiology of a sexual dysfunction is frequently unclear, and clinical judgment is needed. Often, multiple possible explanations need to be explored, using both medical and psychiatric examination procedures.
Hypoactive sexual desire disorder is a psychiatric disorder that occurs in approximately 1.5% of men aged 16-44. The prevalence of low sexual desire, more broadly, is approximately 15%-17% of men. Older men are more likely than men in younger cohorts to experience low desire. Hypoactive sexual desire disorder is characterized by a low desire for sex and absent sexual thoughts or fantasies.
Male hypoactive sexual desire disorder is sometimes associated with erectile and/or ejaculatory problems. Men with this disorder may also have difficulty obtaining an erection, which can lead to a reduced interest in sex. Men with hypoactive sexual desire disorder often report that they no longer initiate sexual activity and that they are minimally receptive to a partner's attempt to initiate. Sexual activities, like masturbation, may occur even in the presence of low sexual desire. Although men are more likely to initiate sexual activity, and thus low desire may be characterized by a pattern of non-initiation, many men may prefer to have their partner initiate sexual activity. In such situations, the man's lack of response to a partner's invitation should be considered when evaluating this disorder.
There are five factors that should be taken into consideration during the assessment and diagnosis of male hypoactive sexual desire disorder:
As described above, not all incidents of low sexual desire in men warrants a diagnosis of Male Hypoactive Sexual Desire Disorder. Medical issues, adverse effects of drugs or medications, or relationship problems can all impact sexual desire.
Many men with male hypoactive sexual desire disorder may have low self-esteem or self-confidence, a decreased sense of masculinity, and may experience depressed affect. Their partners commonly report reduced sexual satisfaction and reduced sexual desire. A man's feelings about himself, his perception of his partner's desire, and a couple's connectivity can all negatively impact sexual desire. Thus, this disorder can interfere with fertility and produce both individual and interpersonal distress.
Age is a significant risk factor for low desire in men. Mood and anxiety disorders, such as major depressive disorder, are a common comorbidity with this population. Endocrine disorders such as hyperorlactinemia can reduce sexual desire in men. Low testosterone levels may also play a role in sexual desire. Male hypoactive sexual desire disorder can also result from unresolved sexual identity issues stemming from gender identity, sexual orientation, lack of adequate sex education and trauma from early life experiences.
As described above, not all incidents of low sexual desire in men warrants a diagnosis of Male Hypoactive Sexual Desire Disorder. Therefore, not all treatments for low sexual desire are psychiatric. If a diagnosis is warranted, there are treatment options available. However, there are few controlled studies evaluating the efficacy of treatment options. Treatment recommendations are published in Psychiatry and Journal of Sex and Marital Therapy.
Controlled studies indicate that the following treatments are effective for Male Hypoactive Sexual Desire Disorder:
In addition, the following treatments have shown promise but have not yet been validated in controlled research: