title: Hypoactive Sexual Desire Disorder: International Society for the Study of Women's Sexual Health (ISSWSH) Expert Consensus Panel Review.
abstract: The objective of the International Society for the Study of Women's Sexual Health expert consensus panel was to develop a concise, clinically relevant, evidence-based review of the epidemiology, physiology, pathogenesis, diagnosis, and treatment of hypoactive sexual desire disorder (HSDD), a sexual dysfunction affecting approximately 10% of adult women. Etiologic factors include conditions or drugs that decrease brain dopamine, melanocortin, oxytocin, and norepinephrine levels and augment brain serotonin, endocannabinoid, prolactin, and opioid levels. Symptoms include lack or loss of motivation to participate in sexual activity due to absent or decreased spontaneous desire, sexual desire in response to erotic cues or stimulation, or ability to maintain desire or interest through sexual activity for at least 6 months, with accompanying distress. Treatment follows a biopsychosocial model and is guided by history and assessment of symptoms. Sex therapy has been the standard treatment, although there is a paucity of studies assessing efficacy, except for mindfulness-based cognitive behavior therapy. Bupropion and buspirone may be considered off-label treatments for HSDD, despite limited safety and efficacy data. Menopausal women with HSDD may benefit from off-label testosterone treatment, as evidenced by multiple clinical trials reporting some efficacy and short-term safety. Currently, flibanserin is the only Food and Drug Administration-approved medication to treat premenopausal women with generalized acquired HSDD. Based on existing data, we hypothesize that all these therapies alter central inhibitory and excitatory pathways. In conclusion, HSDD significantly affects quality of life in women and can effectively be managed by health care providers with appropriate assessments and individualized treatments.
authors.affiliation: Department of Sexual Medicine, Alvarado Hospital, San Diego, CA. Electronic address: dr.irwingoldstein@gmail.com.
authors.forename: Irwin
authors.initials: I
authors.lastname: Goldstein
authors.affiliation: Institute for Sexual Medicine, San Diego, CA.
authors.forename: Noel N
authors.initials: NN
authors.lastname: Kim
authors.affiliation: Department of Psychiatry and Neurobehavioral Sciences and Obstetrics and Gynecology, University of Virginia, Charlottesville.
authors.forename: Anita H
authors.initials: AH
authors.lastname: Clayton
authors.affiliation: Maryland Center for Sexual Health, Johns Hopkins University School of Medicine, Baltimore.
authors.forename: Leonard R
authors.initials: LR
authors.lastname: DeRogatis
authors.affiliation: Sexological Clinic, Psychiatric Center Copenhagen, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Giraldi
authors.affiliation: Weill Cornell Medical College, New York, NY.
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Parish
authors.affiliation: Center for Studies in Behavioral Neurobiology, Department of Psychology, Concordia University, Montréal, QC, Canada.
authors.forename: James
authors.initials: J
authors.lastname: Pfaus
authors.affiliation: George Washington University, Washington, DC.
authors.forename: James A
authors.initials: JA
authors.lastname: Simon
authors.affiliation: Division of Behavioral Medicine, Department of Obstetrics/Gynecology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH.
authors.forename: Sheryl A
authors.initials: SA
authors.lastname: Kingsberg
authors.affiliation: Department of Psychology, University of Texas at Austin.
authors.forename: Cindy
authors.initials: C
authors.lastname: Meston
authors.affiliation: Department of Psychiatry, University of California San Diego, and the Neuroscience Education Institute, San Diego.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Stahl
authors.affiliation: Department of Psychology and Yerkes National Primate Research Center, Emory University, Atlanta, GA.
authors.forename: Kim
authors.initials: K
authors.lastname: Wallen
authors.affiliation: Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia.
authors.forename: Roisin
authors.initials: R
authors.lastname: Worsley
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003245:Consensus Statements as Topic; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007989:Libido / Q000187:drug effects*; D017366:Serotonin Receptor Agonists / Q000627:therapeutic use; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D020018:Sexual Dysfunctions, Psychological / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D013739:Testosterone / Q000627:therapeutic use
chemical_list: D017366:Serotonin Receptor Agonists; D017367:Selective Serotonin Reuptake Inhibitors; D013739:Testosterone