Hypoactive sexual desire (lack of desire for sexual intimacy), is the most common of sexual dysfunctions. It is defined as the persistent or recurrent deficiency or absence of sexual fantasies &/or desire for or receptivity to, sexual activity, which causes personal distress.

Etiology

Numerous factors including physiologic (e.g. hormonal fluctuations), psychosexual (e.g. marital desire discrepancies), as well as cultural/educational, can affect sexual desire expression in women.

Falling serum estradiol as well as testosterone levels (e.g. in the perimepausal years), have been associated with hypoactive sexual desire and arousal disorders

Medications, including antidepressants (SSRI's & tricyclic), tranquilizers, antihypertensives, and anticonvulsants, are often associated with sexual dysfunctions.

Therapy

Libidinal enhancing activities are encouraged. These may include encouraging erotic thoughts and fantasies (e.g. erotic literature & videos), regular exercises (e.g. cycling to increase blood flow to genital area), and self exploration/stimulation.

Testosterone supplementation is beneficial in women with low free testosterone levels. Often used as a compounded cream, it is applied 2-3 times weekly. Results are usually observed within 4-8 weeks.

Estrogen supplementation in perimenopausal women with serum estradiol levels < 50 pg/ml, often restores sexual desire to pre-menopausal levels.

Alteration of medications (e.g. SSRI antidepressants or birth control pills), is often necessary to restore sexual desire. This could be achieved by changing the dose, substituting an alternative regimen of therapy, or adding medications with prosexual effects.

A number of other drugs (DHEA, L-Arginine) are currently being investigated for their potential benefit in the treatment of sexual desire and arousal disorders.