Sexual Health
CMECNE

A Patient Complains of Low Sexual Desire – Making an Accurate Diagnosis

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Learning Objectives and CME/Disclosure Information

CLINICAL ACTIONS:

It is often difficult for patient to differentiate between desire / libido, arousal and aversion disorders. The provider might want to ask some of the follow-up questions in order to help them and their patients distinguish between primary concerns. Once they have more accurately clarified issues, they may discuss making an appropriate referral.

  • Once you start having sex, is your body responding?
    • No, indicates a problem with arousal that can be an independent problem or can be the primary problem resulting in low desire
  • If, when you had sex, the sex itself was “good” and satisfying, would you want to have sex again?
    • Yes, indicates the likelihood that the problem may be arousal rather than desire
    • If the patient responds that the quality of sex is good but she still has no interest in repeating the experience, then she is describing a clear lack of desire
  • Is your disinterest in sex universal? Or are you interested in sex with other people, but not necessarily your partner?
  • When was the last time you had sex? If over a month, ascertain if that is due to circumstances, their partner’s disinterest or their disinterest
  • Consider administering the Female Sexual Functioning Index (FSFI)
    • A score of 6 or lower in the desire domain suggests a diagnosis of low desire

SYNOPSIS:

Women’s sexual concerns are often interlinked. A woman can become avoidant of sex because of a lack of an arousal response or because of pain she experiences, or she can be disinterested or avoidant, independent of other issues. Any or all of these can be overlapping, and because colloquial descriptions of problems do not necessarily match clinical diagnosis, it is important to distinguish between various concerns in order to provide appropriate support, referral and treatment.

KEY POINTS:

It is critical for the clinician to differentiate wherever possible between sexual concerns despite the fact that the patient may be unable to do so for herself.

  • Arousal disorders describe an inability to get excited or respond during sexual activity.
    • Women will complain of not getting “fluttery, wet, tingly or turned on.” Or they will complain of a lag time where it “takes forever” to get “turned on”
    •  Generally, this is comorbid with orgasmic problems but not always
    • Problems with arousal can be easily confused with desire issues, but they are different problems and may need to be treated differently
  • Pure desire problems describe a lack of interest in sexual activity even when the sex itself was satisfying and orgasm is easily achieved
  • While these two problems often overlap, they may be treated differently. Helping your patient understand the difference will be helpful in providing support and referrals

Learn More – Primary Sources:

Sexual desire and the female sexual function index (FSFI)

ACOG Practice Bulletin 213: Female Sexual Dysfunction

AAFP: Sexual Dysfunction in Women – A Practical Approach

ISSWSH Expert Consensus Panel Review: Hypoactive Sexual Desire Disorder 

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