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A lot of people have no problem talking about sex with their friends—as long as the convos are about pleasurable or funny things. But when it comes to issues like a dwindling sex drive, people tend to clam up. Perhaps that’s because many women are not aware that a distressing and long-term lack of sexual desire can actually be a sign of a legit condition called acquired, generalized hypoactive sexual desire disorder (HSDD). Plus, more generally speaking, there’s still stigma around female sexuality.

All that said, it’s not surprising that most women with frustrating low sexual desire do not seek help—mostly out of embarrassment or fear that their problem will minimized, according to research. But no one should have to live with a conditionwhen there are solutions out there.

In an effort to empower all women, let’s start talking. If you feel like your libido has ghosted you, you’re not alone. Read on to learn more about HSDD and what can help if you experience it.

What is hypoactive sexual desire disorder?

You know what it’s like to want to tear your partner’s clothing off the second they come home, and countless women have prob fantasized about that *special* celeb as they’re using their favorite vibrator. Those with HSDD have had moments like those as well. But generally, they have little or no sex drive.

This may include a lack of motivation to have sex or masturbate, decreased spontaneous desire for sex, loss of desire to initiate sex, being unable to respond to sexual stimulation such as touch or erotic movies, and the absence of sexual fantasies, explains Diane Todd Pace, PhD, professor in the Colleges of Nursing and Medicine at the University of Tennessee Health Science Center.

And, most importantly for a diagnosis, this lack of desire must cause distress. That means that if you are not frustrated by ongoing low sexual desire, it’s not HSDD. According to an article in the peer-reviewed journal Mayo Clinic Proceedings, about 10 percent of women in the U.S. have HSDD.

What causes HSDD?

Sexual health experts use what’s called the biopsychosocial model to explain the different factors that play a role in HSDD:

  • Biologically, the desire response is thought to be a balance of excitation and inhibition mechanisms in the brain. Anything that heightens the brain inhibitory response will dampen any excitation and put the brakes on your sexual appetite. Certain health conditions and medications encourage inhibition to take over.
  • Psychological factors such as anxiety and stress may also be responsible for low sexual desire.
  • And social, cultural and religious norms can cause anyone to feel “bad” about sexual signals from their body or about being sexual, says Sheryl Kingsberg, PhD, chief of behavioral medicine at University Hospitals Cleveland Medical Center.

    Other factors connected to decreased desire include pregnancy, childbirth, and relationship strife with your partner, Kingsberg says. If you experience any of the things above it doesn’t mean you will develop HSDD, but each can affect your libido.

    Isn’t it just normal for my sex drive to ebb and flow?

    What is a “normal” sex drive is different for every person. Only you can determine if your desire has waned. While all of the above causes could affect your sex drive on any given day, it’s the combination of a persistently absent libido (without any underlying medical condition) and feeling distressed over your low levels of desire that is the hallmark of HSDD.

    You said HSDD is treatable. What can I do if I think I have it?

    Talk to your doctor, who will ask a few simple questions to determine if you have HSDD. However, if your doctor dismisses your concerns or doesn’t know how to treat HSDD, ask for a referral, Pace says. “This is a quality-of-life issue, and there are a variety of treatment options,” she adds. There is no reason to stay silent and unhappy.

    Medication is one option for pre-menopausal women diagnosed with acquired, generalized HSDD, and there are two FDA-approved treatments. One of them is an auto injector called

    Vyleesi®(bremelanotide injection), which is an “as-needed treatment” taken 45 minutes before anticipated sexual activity.

    The upside of Vyleesi® is you can work it into your lifestyle, Pace says. You don’t have to worry about skipping a pill. However, you cannot take Vyleesi® more than one time within 24 hours or more than 8 times per month. Other things to know about the drug: Vyleesi® is only for pre-menopausal women and, because it briefly increases blood pressure, those with cardiovascular disease or uncontrolled hypertension should not take it. It’s also worth noting that the most common side effects of Vyleesi® are nausea, injection site reactions, headache, vomiting, flushing and other more serious side effects.

    Is there anything else that helps?

    While medication can address the biological side of HSDD, therapy can address the psychological side. “Cognitive behavioral therapy may be very effective for women with a history of HSDD,”says Lisa Chism, DNP, APRN, NCMP, FAANP, a certified sexuality counselorand the clinical director of the Women’s Wellness Clinic at Karmanos Cancer Institute in Detroit.

    CBT works to change thoughts and behaviors that inhibit sexual desire while also working to change sexual behavior so you focus on pleasure and don’t avoid sexual activity. CBT may also help you change how you think of desire and sex. Sex therapists can provide additional help by not only validating what you are experiencing, but by helping you regain your sexuality and confidence. So be your own advocate, speak up, and get the care you need.


    Vyleesi® is not for use in postmenopausal women or in men, and is not indicated to improve sexual performance. Don’t use Vyleesi® if you have uncontrolled high blood pressure or known cardiovascular disease. The most common side effects of Vyleesi® include: nausea, flushing, injection site reactions, headache, vomiting. These are not all the possible side effects of Vyleesi®; please see Important Safety Information here.

    Vyleesi® is a prescription medicine used to treat hypoactive (low) sexual desire disorder (HSDD) in women who have not gone through menopause, who have not had problems with low sexual desire in the past, and who have low sexual desire no matter the type of sexual activity, the situation, or the sexual partner. Women with HSDD have low sexual desire that is troubling to them. Their low sexual desire is not due to:

    • a medical or mental health problem
    • problems in the relationship
    • medicine or other drug use

    Vyleesi® is not for the treatment of HSDD in women who have gone through menopause or in men.
    Vyleesi® is not for use to improve sexual performance.
    Vyleesi® is not for use in children.

    * International Society for Sexual Medicine. Sexual Health Q&A: What is hypoactive sexual desire disorder (HSDD) in women? What causes it? Accessed March 26, 2019.

    Kingsberg SA, Clayton AH, Pfaus JG. The female sexual response: current models, neurobiological underpinnings and agents currently approved or under investigation for the treatment of hypoactive sexual desire disorder. CNS Drugs. 2015;29(11):915-933.

    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.

    ** American College of Obstetricians and Gynecologists. ​Finding Solutions for Female Sexual Dysfunction​.​ Accessed March 26, 2019.

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