When it comes to sexual health, one of the biggest challenges women face today is that they don’t openly talk about it— and probably no one is asking, not even their doctors. We often act “as if women do not have sexual drive or desire,” says Dr. Marla Shapiro, a family physician who specializes in women’s health and preventative medicine. “Often health care providers are not trained in this area and may feel they have nothing to offer in management and advice.”
For most women, a typical visit to her family physician or gynecologist involves the usual annual exams and very basic questions in terms of sexual health, like: “Are you sexually active?” and/or “Do you want birth control?” But in order to create a comprehensive snapshot of the overall health of a female patient, her level of sexual desire should also be addressed.1
“We have not prioritized women’s sexual desire in the same way we have for men,” Dr. Shapiro says. Instead, “women feel that changes in sexuality are a function of aging and there is nothing to do about it.” Studies show, however, that loss of desire is significant among adult women — In one US survey, about 38 percent identify problems with sexual desire and 1 in 10 women report their lack of desire is causing significant distress.2,3
It’s the latter group that has Dr. Shapiro concerned. “The most important aspect of this conversation for me is the feeling of distress that a woman may experience related to her sexual desire.” Feeling distressed by their level of sexual desire is one of the key signs that a patient could be experiencing a medical condition called Hypoactive Sexual Desire Disorder (HSDD), the most common form of female sexual dysfunction.2
HSDD is defined as either a persistent or a recurrent deficiency or loss of sexual thoughts, fantasies and or desire for sexual activity, which occurs frequently and lasts for months and leads to marked personal distress and interpersonal difficulties.3 In other words, says Dr. Shapiro, “if a woman’s lack of interest in sex is ongoing and she is deeply troubled by it, it could be HSDD.”
“It is similar to losing your appetite for food, or depression — you lose interest in things that used to give you pleasure,” says Dr. Shapiro of the evident shift in desire that can happen when HSDD occurs. The burden of living with HSDD also typically extends beyond the bedroom, with 71% of patients describing feelings of hopelessness.4 “Women will talk about wanting to want,” she adds.
So why hasn’t this medically recognized condition been taken more seriously? Dr. Shapiro suggests that part of the reason is because of the wide range of excuses and misconceptions surrounding it. She says she has heard phrases like, “It doesn’t exist,” “It’s in your head,” and “It’s normal” to dismiss HSDD symptoms. On top of that, women who are suffering are often advised to take a vacation, change partners, or just “live with it.”
There is no reason for women to accept any of those myths as fact. Dr. Shapiro says, “There is no expiration date for passion and romance and desire.”
Low sexual desire has been studied since the 1970s, so there are four decades of research on this subject.5
There is no one single thing that causes HSDD. It can be caused by physical, psychological and or emotional conditions. Studies suggest that your brain can affect desire. In one study, which compared the brain scans of women with HSDD to those that did not, it was observed that different regions in the brain are activated in women with HSDD in comparison to those who don’t have the disorder. Researchers think that these differences might illustrate that women with HSDD process arousing visual stimuli and retrieve past erotic experiences in a different way than other women. Women with HSDD might also be focusing more on their own responses to sexual stimuli than a woman without HSDD.6a, 6b
If a woman thinks she could be suffering from HSDD, if she remembers a sex drive she was once happy with but it’s now missing, the best way to get started on treatment is by visiting a physician who will assist with the correct diagnosis and approach. Diagnosis involves answering a list of questions — similar to the ones found on the Right to Desire’s sexual quiz — via an assessment tool called the Decreased Sexual Desire Screener (DSDS).7
The DSDS consists of the following questions:
- In the past was your level of desire good and or satisfying?
- Has there been a decrease in your level of desire or interest?
- Are you bothered by your decreased desire or interest?
- Would you like your level of desire to increase?
In addition, patients are asked to indicate if there are any factors that could be contributing to their decrease in sexual desire, such as depression, a medical condition, recent surgery, medication, her partner’s sexual problems, or distress in the relationship itself.7
If the physician diagnoses or suspects HSDD, a number of treatment options or combination of options may be discussed.
Bottom line: Women have the same right to desire as men, so they should advocate for themselves when it comes to sex. “If your healthcare practitioner doesn’t open the door to this conversation, make sure you do,” Dr. Shapiro advises. “Make it a priority. Write down your questions and concerns and address them early in the appointment.” Even the World Health Organization declared that sexual health, including sexual satisfaction, is a basic human right!
To learn more about HSDD and take a confidential quiz to learn more about your desire, visit RightToDesire.ca.
2. Shifren JL, Monz BU, Russo PA, et al. Sexual problems and distress in United States women: prevalence and correlates.
Obstet Gynecol. 2008;112(5):970-8.
3. Sexual Medicine Society of North America. Understanding HSDD. Accessed February 2019 at
4. Leiblum SR, Koochaki PE, Rodenberg CA, Barton IP, Rosen RC. Hypoactive sexual desire disorder in postmenopausal
5. Helen Singer Kaplan MD, PhD (1977) Hypoactive sexual desire, Journal of Sex & Marital Therapy, 3:1, 3-9, DOI:
6. a) Arnow BA, Millheiser L, Garrett A, et al. Women with hypoactive sexual desire disorder compared to normal females: A
functional magnetic resonance imaging study. Neuroscience. 2009; 158:484-502.
b) Holstege G, Weijmar- Schultz W. How combined serotonin-1A receptor agonist and 2A- receptor antagonist can heal
hypoactive sexual desire disorder (HSDD). Poster presented at Neuroscience 2014 the Society for Neuroscience 2014 Annual
Meeting (SfN); November 15-19, 2014; Washington, DC.
Desire Screener (DSDS): A brief diagnostic instrument for generalized acquired female Hypoactive Sexual Desire Disorder