The International Society for the Study of Women's Sexual Health Process of Care for Management of Hypoactive Sexual Desire Disorder in Women

Abstract

The International Society for the Study of Women's Sexual Health process of care (POC) for management of hypoactive sexual desire disorder (HSDD) algorithm was developed to provide evidence-based guidelines for diagnosis and treatment of HSDD in women by health care professionals. Affecting 10% of adult females, HSDD is associated with negative emotional and psychological states and medical conditions including depression. The algorithm was developed using a modified Delphi method to reach consensus among the 17 international panelists representing multiple disciplines. The POC starts with the health care professional asking about sexual concerns, focusing on issues related to low sexual desire/interest. Diagnosis includes distinguishing between generalized acquired HSDD and other forms of low sexual interest. Biopsychosocial assessment of potentially modifiable factors facilitates initiation of treatment with education, modification of potentially modifiable factors, and, if needed, additional therapeutic intervention: sex therapy, central nervous system agents, and hormonal therapy, guided in part by menopausal status. Sex therapy includes behavior therapy, cognitive behavior therapy, and mindfulness. The only central nervous system agent currently approved by the US Food and Drug Administration (FDA) for HSDD is flibanserin in premenopausal women; use of flibanserin in postmenopausal women with HSDD is supported by data but is not FDA approved. Hormonal therapy includes off-label use of testosterone in postmenopausal women with HSDD, which is supported by data but not FDA approved. The POC incorporates monitoring the progress of therapy. In conclusion, the International Society for the Study of Women's Sexual Health POC for the management of women with HSDD provides a rational, evidence-based guideline for health care professionals to manage patients with appropriate assessments and individualized treatments.

Global Consensus Position Statement on the use of Testosterone Therapy for Women

“…a Hypoactive Sexual Desire Disorder/Dysfunction (HSDD) and Female Sexual Arousal Disorder (FSAD) are distinct conditions which should be categorized separately when considering the impact of androgens on their clinical presentation and response to treatment (Grade B). b While HSDD and FSAD overlap, they have distinct etiologies, risk factors, clinical features, and responses to psychological and biological interventions [10] (Grade B). c Traditional specifiers, i.e.…”

“…c Traditional specifiers, i.e. lifelong vs acquired; generalized vs. situational, should be retained and utilized to further categorize and stratify treatments for HSDD and other female sexual disorders/ dysfunctions [10]. d The diagnosis of HSDD in clinical practice should be based on thorough clinical assessment [11] guided by available diagnostic criteria such as ISSWSH [12,13] or the International Classification of Diseases 11th Edition [14] (Expert Opinion).…”

Testosterone therapy for women with low sexual desire: a position statement from the Brazilian Society of Endocrinology and Metabolism

“…These manifestations are "combined with clinically significant personal distress that includes frustration, grief, guilt, incompetence, loss, sadness, sorrow, or worry" (37, p. 468). A sexual history and/or the use of a validated instrument, such as the Decreased Sexual Desire Screener (DSDS) (38), are recommended for confirming the diagnosis and determining the type of HSDD (33,37). In women going through the natural menopausal transition, a comprehensive, longitudinal study has found that prior function and relationship factors have a stronger impact on female sexual function than hormone concentrations (A) (39).…”

What are the challenges in prescribing pharmacotherapy for female sexual dysfunctions?

“…Safety data are currently available for the first year of therapy [5][6][7]. Differently from VVA/GSM, in which signs associated with symptoms are visible and can be monitored through a gynecological examination, the assessment and manage- ment of hypoactive desire disorder (HSDD) require screener questions and/or inquiring about a history of modifiable biopsychosocial factors influencing sexual health [8]. When low desire presents simultaneously with VVA/GSM, the former may resolve following the adequate treatment of dyspareunia and other urogenital symptoms.…”