[Editor's note: This article was reviewed and updated on February 20, 2020 to reflect the news about an additional drug (Vyleesi) for the treatment of HSDD.]
If you're a woman who's been experiencing low interest in sex for six months or more and this lack of interest is causing personal distress, then you could be suffering from Hypoactive (low) Sexual Desire Disorder (HSDD).
The Internal Society for Sexual Medicine (ISSM) says HSDD affects 10% of women across all age groups. The ISSM goes on to say, "HSDD has deleterious effects upon women’s overall health and/or couples’ well-being. It may cause psychological, emotional and/or relationship distress which, in some cases, is severe and debilitating. HSDD can be a major impediment to life satisfaction and happiness; it should never be considered trivial, unimportant or illusory."
Dr. Angel Marie Johnson, director of our Women's Health Center, echoes the ISSM's statements. "Unfortunately, sexual dysfunction is still seen as a taboo subject, even as the number of TV commercials for sexual dysfunction in men seemingly increase," she says. "I want every woman reading this article to know she is not alone and that her sexual health matters. Sex is a natural biological need that all humans have, men and women alike."
In an effort to remove the stigma, Dr. Johnson makes it a habit to ask her patients about their sexual health. Some bristle at this line of questioning because they're not used to discussing it.
"I definitely have women who will say, 'Oh doctor, I'm 65.' Or 'Oh doctor, I'm 80.' But you need to keep this in mind: Age does not matter," Dr. Johnson says. "My husband is an interventional spine physician and part of what he does includes assessing a patient's activities of daily living. Sexual intercourse is an activity of daily living. You don't have to have sex daily, unless you want to, but it is a normal, healthy activity."
Dr. Johnson says when she broaches the subject with her patients, the conversation can go in any number of directions from that point, but it's her job to initiate the conversation.
"I want to help women find their voice," she says. "If she's dealing with a lack of sexual desire and it's distressing her, then we'll discuss options. My patients welcome the validation and appreciate knowing they're not alone and that there are treatments available."
When it comes to treatment, the challenge is that sexual function and arousal in women aren't linear after all (this had been the original thought decades ago). This fact further complicates the diagnosis and treatment of sexual dysfunction as the origin can vary from person to person. The ISSM notes, "The specific biological basis of HSDD, like that of depression, is the subject of ongoing scientific research. However, there is already ample evidence that physiological, psychological and socio-cultural factors may all play important roles."
Dr. Johnson concurs that "unpacking" the origin of a patient's sexual dysfunction can be complex. "Women often don't realize that the brain is one of the most powerful sexual organs," she says. "And because the brain is involved—and when I say 'the brain', I mean the mental aspects as well as brain chemicals or physiology —there can be any number of factors contributing to the decrease in desire. Maybe there's discord in the relationship. Maybe there's been a recent trauma. Maybe the woman is experiencing symptoms of menopause, but maybe not. Or maybe there's indeed a chemical imbalance."
Regarding the latter, an FDA-approved medicine is available for HSDD due to chemical imbalances in the brain. It's called Addyi, and the Addyi website describes the medication as "a prescription, non-hormonal pill taken daily at bedtime. In clinical studies, Addyi demonstrated improvement on HSDD symptoms, including increasing desire, number of satisfying sexual events, and decreasing distress."
Dr. Johnson says she's seen some patients experience success with Addyi, but she is quick to note that patients have to watch their alcohol consumption while taking Addyi. (The website lists additional important safety information that women and their partners should be aware of.)
Another medication called Intrarosa might also help with HSDD, although its main indication is for painful intercourse due to vaginal dryness. Dr. Johnson explains, "Intrarosa is a steroid in the form of a vaginal suppository. The steroid, also known as synthetic DHEA, is the building block of estrogen and testosterone. Estrogen in the vagina causes cellular changes in the vagina, resulting in increased lubrication and decreased pain with intercourse. Because DHEA also increases testosterone, patients on Intrarosa commonly report an increase in sexual desire."
Dr. Johnson adds, "Thus, when I have a patient who has vaginal dryness, pain with intercourse, and low desire, that's when I'll say, 'How about you try this? Because it is one medicine that can potentially treat all those areas."
The FDA also recently approved a drug called Vyleesi, which is self-injected medication that increases sexual desire. Read more about Vyleesi here.
When it comes to sexual dysfunction, Dr. Johnson says the most important thing is to talk about it with your doctor. And if your PCP doesn't give you the support you need, seek a specialist, like Dr. Johnson, who is a urogynecologist.
"It's your life and your joy, and both matter," she says. "Have an honest conversation with a doctor you like and trust. And if you don't have a doctor like that, find one."
If you're a woman in the greater Boston area and you'd like to discuss sexual dysfunction in a comfortable and safe setting, consider Greater Boston Urology and make an appointment with Dr. Johnson today.