Inhibited sexual desire (ISD) is a medical condition with only one symptom: low sexual desire.
According to the DSM/ICD-10, ISD is more correctly referred to as HSDD or
It’s important to distinguish HSDD from asexuality. Asexuality is a type of sexual orientation defined as a general lack of sexual attraction, while HSDD is a condition focused on a lack of sexual desire.
HSDD is one of the more common problems couples face today.
HSDD can be a primary or secondary condition. This is an important distinction for treatment purposes. It’s a primary condition if the person with HSDD has never had sexual desire.
It’s a secondary condition if the person with HSDD began a relationship with normal sexual desire but later became disinterested.
HSDD can also be understood as a relationship issue, which helps to guide medical or psychological treatment.
Situational HSDD means that the person with HSDD has sexual desire for others, but not for their partner. General HSDD means the person with HSDD has no sexual desire for anyone.
There’s no true normal range for sexual desire because it naturally fluctuates throughout life.
Major life changes that can affect your sexual desire include:
- partner changes (marriage or divorce)
- physical or psychological disability
- work and life imbalance
People seek help when HSDD puts stress on their relationships. However, the problem isn’t always a case of HSDD. One partner may have an overactive sexual desire. This creates a ‘sexual mismatch,’ which also puts undue strain on a relationship. When this happens, it can:
- erode affection
- cause neglect of the nonsexual relationship
- cause the other partner to lose sexual interest
HSDD is often an intimacy issue. Common relationship factors that can impact sexual desire include:
- toxic communication
- controlling attitudes
- contempt or criticism
- breach of trust (infidelity)
- lack of emotional connection
- spending too little time alone
People who are most at risk of developing HSDD have experienced trauma (incest, rape, or sexual abuse), or were taught negative attitudes about sex by their family (or by their religion) while growing up.
There are many medical and psychological factors that can also hamper sexual desire, including:
- painful intercourse
- erectile dysfunction (impotence)
- delayed ejaculation (inability to ejaculate during intercourse)
- negative thinking patterns (anger, dependency, fear of intimacy, or feelings of rejection)
- pregnancy and breastfeeding
- mental health problems (depression, anxiety, low self-esteem)
- use/overuse of alcohol and street drugs
- chronic illness
- pain and fatigue
- side effects of medicines (especially antidepressants and anti-seizure drugs)
- hormonal changes
- low testosterone (in both women and men)
Certain conditions can affect libido (sexual desire). The most common of these are:
- high blood pressure
- coronary heart disease
- sexually transmitted diseases (STDs)
- neurological issues
Women who have had breast or vaginal surgery may experience sexual dysfunction, poor body image, and inhibited sexual desire.
Erectile dysfunction (ED) is the inability to achieve an erection of the penis. This can cause HSDD in the person with the penis, who may feel a failure sexually.
Perceived failure in both men and women (failure to orgasm, for example) can cause the individual experiencing the dysfunction to have HSDD.
Erectile dysfunction isn’t necessarily due to aging. It can be a sign of medical problems such as:
In many HSDD cases, medical conditions aren’t as influential as each partner’s attitude about sexual intimacy.
You may have HSDD if you experience low sexual desire and it causes you distress personally or in your relationship.
Your doctor can look for causes of HSDD and recommend strategies that may help. After recording your medical history, the doctor may prescribe some or all of the following tests:
- blood tests to check for diabetes, high cholesterol, thyroid problems, or low testosterone
- pelvic exam to check for physical changes, such as vaginal dryness, painful areas, or thinning of the vaginal walls
- blood pressure check
- tests for heart disease
- prostate gland examination
After treating any medical conditions, your doctor may recommend evaluation by a sex therapist or psychiatrist, either individually or as a couple.
Psychological and sex therapy are the primary treatments for HSDD. Many couples first need marriage counseling to improve their nonsexual relationship before addressing the sexual component directly.
Communication training is one option that teaches couples how to:
- show affection and empathy
- respect each other’s feelings and perspectives
- resolve differences
- express anger in positive ways
Sex therapy will help couples learn how to:
- devote time and energy to sexual activities
- find interesting ways to sexually approach their partner
- decline sexual invitations tactfully
You may need individual counseling if your HSDD stems from sexual trauma or sexual negativity learned as a child.
Private counseling or drug therapy can treat male problems such as impotence or delayed ejaculation. Drugs such as Viagra can help with ED. It’s important to keep in mind that these drugs only enable erections; they don’t cause them.
The hormones testosterone and estrogen greatly influence sex drive. Small doses of estrogen delivered via a vaginal cream or a skin patch can increase blood flow to the vagina. However, long-term estrogen therapy
Female testosterone therapy may also help, but it isn’t yet approved by the Food and Drug Administration for the treatment of female sexual dysfunction.
Testosterone side effects include:
- mood and personality changes
- excessive body hair
Certain lifestyle changes can have a positive effect on sexual desire while also improving overall health.
- Set aside time for intimacy. If one or both partners’ schedules are very busy, it can help to put dates on your calendar to make intimacy a priority in your relationship.
- Exercise. Working out can elevate your mood, improve libido, increase stamina, and create a more positive self-image.
- Communicate. Talking openly and honestly fosters a closer emotional connection. It may also help to tell your partner your sexual likes and dislikes.
- Manage stress. Learning better ways to manage financial pressures, work stress, and the hassles of daily life can help you to relax.
Couples therapy is often a successful treatment for HSDD.
Counseling can be a lengthy process, but it can enhance a couple’s attitude toward each other and improve their general outlook on life.