Hypoactive Sexual Desire

Definitions and Diagnostic Criteria

The most frequently presenting sexual desire disorder is deficiency of sexual desire, which is termed hypoactive sexual drive. The DSM-IV (American Psychiatric Association 1994) criteria for hypoactive sexual desire disorder are presented in Table 63-1. The essential feature is a deficiency or absence of sexual fantasy or desire for sexual activity that causes marked personal distress or interpersonal difficulty. It is interpersonal difficulty that usually prompts a person to seek help. This difficulty arises when the two people in a relationship have different intensities and frequencies of sexual desire. Regrettably, in such situations of desire discrepancy, it is usually the person with the lower level of sexual desire who is designated the "patient," and attempts are made to enhance that person's sexual desire. Another not uncommon interpersonal difficulty occurs when one particular partner never or only rarely initiates sexual activity but nonetheless happily participates and often experiences arousal and orgasm following sexual advances from the other partner. The perceived problem here is one of deficiency in proceptivity (i.e., seeking or initiating sexual activity).

Although various authors have attempted to define "normal" levels of sexual desire, there is no generally accepted criterion of normality. The intensity and frequency of sexual desire vary considerably, both in the population and over time within a particular individual. These dimensions, therefore, fall on a continuum extending from no desire at all to extremely frequent, highly intense sexual desire. Except where the higher levels of sexual desire disrupt life or lead to antisocial behavior, no point on this continuum can be considered abnormal. Hence, in the DSM-IV criteria for hypoactive sexual desire disorder, the judgment of deficiency or absence is left to the clinician, who must take into account factors that affect sexual functioning, such as age and the context of the person's life.