Hypoactive Sexual Desire - Assessment

It is essential at the outset of the assessment process to define exactly what a patient means by his or her complaint of low or absent sexual desire. The process includes ascertaining the reference against which the patient judges him- or herself as having low sexual desire. The reference may be a within-subject change from a higher level; if so, can the patient identify the time point at which the change occurred and recall what happened, in terms of life events, at that time point? Alternatively, patients may judge themselves against the level of their partner's sexual desire, a referent suggestive of a sexual desire discrepancy within the relationship. A frequent reference, however, is expectation (often unrealistically high) - the level of desire the patient expects to have.

The conceptual model proposed by S. Levine provides a helpful basis for the assessment and management of sexual desire disorders. Levine's model consists of three principal components: 1) a biological drive component generated by neuroendocrine mechanisms, 2) a cognitive or attitudinal component ("sexual wish"), and 3) affective or interpersonal components ("sexual motive," or willingness to engage in sexual behavior). All three components should be evaluated in patients presenting with hypoactive sexual desire disorder. It must be recognized, however, that the relative importance of these three components varies considerably. In particular, a person in whom the biological drive component is deficient can participate in - and may even initiate - sexual behavior if he or she has a desire and willingness to be sexual. Similarly, a person whose biological drive is strong may not wish to behave sexually or be willing to do so in a particular situation.

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