Hypoactive Sexual Desire - Comorbidity With Other Sexual Difficulties

Hypoactive sexual desire disorder may exist as an isolated sexual problem, with the presenting person being able to experience sexual arousal and orgasm. However, it is not uncommon for men and women to lose sexual desire when experiencing another sexual dysfunction. This response can be seen as a defense mechanism to prevent the humiliation of failed or painful sexual activity. In one report, 40% of subjects presenting with a primary diagnosis of hypoactive sexual desire disorder had secondary diagnoses of arousal and orgasm disorders. Addressing hypoactive sexual desire in the management of patients presenting with other sexual problems is important, because its presence often adversely affects the therapy outcome of the other sexual problems.

The common association of hypoactive sexual desire with other sexual problems highlights the important role of self-confidence in sexual performance as a supportive factor in intact sexual desire. Conditions such as erectile dysfunction and premature ejaculation, with their associated performance anxiety, frequently appear to trigger loss of sexual desire, which comes to represent a significant component in the vicious circle of reduced frequency of sexual contact, reduced self-confidence, and further reduced desire levels. The fear and concern that accompany body-image alteration in conditions such as Peyronie's disease are equally and sometimes more powerful desire suppressants.

The notion that men with raised levels of performance anxiety suppress desire in order to restrict the frequency of experience of failure may offer insight into the behavior of women, who perhaps never gain baseline levels of sexual self-confidence in the first place. Socialized to experience higher levels of body-image and sexual inadequacy in the first place, women may actively suppress desire, thereby reducing their opportunities to experience sexual and performance anxiety; in this way, low desire may play an important role in comfort maintenance. Many women presenting for psychosexual therapy experience their sexuality as problematic, unpredictable, and carrying enormous potential for embarrassment and rejection. These factors need to be borne in mind when tailoring treatment programs for women with lowered levels of desire, because other strategies for self-protection may need to be devised and substituted.

Such processes may be still more marked in women with other sexual dysfunctions. Dyspareunia is notable in its association with hypoactive desire, pain on intercourse being a logically demotivating factor for sexual contact and a powerful conditioner of altered behavioral patterns. Classically, women with primary vaginismus will describe themselves as also having low levels of sexual desire but are frequently unable to say which condition came first. Surgical intervention, whether associated with pathological changes or childbirth, is sometimes followed by varying degrees of dyspareunia, which may result in secondary vaginismus. The actual experience or fantasy of permanent genital damage - of being "spoiled" - carries the likelihood of withdrawal from a sexual partner, response anxiety, and lowered sexual desire.