title: BIOPSYCHOSOCIAL DETERMINANTS OF HYPOACTIVE SEXUAL DESIRE IN WOMEN: A NARRATIVE REVIEW.
abstract: BACKGROUND
  As a mental response to sexual stimuli, sexual desire determines human sexual behavior and represents the cognitive capacity of sexual stimulation, so that avoiding sexual activity has a very negative effect on the discharge of intimacy and joy in couple's relationship and threatens the stability relationship, which can finally end in sexual dissatisfaction and divorce; it may even affect the reproduction. This study, reviews the literature on biopsychosocial determinants of hypoactive sexual desire disorder in women in childbearing ages.
  
  
  METHODS
  The search was done from January to March 2015 by the use of the data bases ProQuest, Pubmed, CINAHL, Ovid and Medline and the words sexual desire, related factors and biopsychosocial determinants were used as free text words. The words reduce sexual desire, hypoactive sexual desire disorder, dyadic relationship, biopsychosocial factors and women were used as keywords in the search. Also, the articles focusing on any aspects of sexual desire such as biological, social and psychological factors and relationship factors alone or integrated, were included in the study. The articles which specifically targeted the hypoactive sexual desire disorder in pregnant and lactating women and also the articles targeting biopsychosocial factors related to other types of sexual function disorder such as arousal disorder, orgasm disorder and dyspareunia, were all excluded from this study.
  
  
  RESULTS
  After reviewing the literature, the findings were categorized in three main class of effect of biologic factors on sexual desire and sexual hypoactivity, the effect of psychological factors on sexual desire and the effect of cultural factors and couple's relationship on sexual desire, each of these domains cover a wide range (such as hormonal changes, chronic diseases, psychological difficulties (perceived stress, anxiety, depression). Incompatibility of couples, the spouse's sexual function disorder) which may overlap. Because of the complexity of etiology and the difficulty of treating hypoactive sexual desire disorder, it is necessary to use biopsychosocial approaches to diagnose and treat the disorder.
  
  
  CONCLUSIONS
  According to the findings of this reviewing study, the factors able to affect sexual desire and activity are not distinct and often overlap, therefore, the complicated etiology of hypoactive sexual desire disorder often needs multidimensional intervention to use biopsychosocial approach; Multi factor assessment with a combination of psychological, physical, social and hormonal intervention can be effective in making strategies to treat the symptoms of HSDD.
authors.affiliation: Department of Reproductive Health and Midwifery, Nasibeh Nursing and Midwifery Faculty, Mazandaran University of Medical Sciences, Sari, Iran; Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Mina
authors.initials: M
authors.lastname: Malary
authors.affiliation: Department of Reproductive Health and Midwifery, Nasibeh Nursing and Midwifery Faculty, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Soghra
authors.initials: S
authors.lastname: Khani
authors.affiliation: Department of Psychiatry and Research Center for Psychiatry and Behavioral Sciences, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Pourasghar
authors.affiliation: Health Sciences Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Mahmood
authors.initials: M
authors.lastname: Moosazadeh
authors.affiliation: Department of Reproductive Health and Midwifery, Nasibeh Nursing and Midwifery Faculty, Mazandaran University of Medical Sciences, Sari, Iran; Traditional and Complementary Medicine Research Centre, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Zeinab
authors.initials: Z
authors.lastname: Hamzehgardeshi
keywords: hypoactive sexual desire; related factors; women