HYPO AND HYPERACTIVE

SEXUAL DESIRE DISORDERS

– OVERVIEW

Presenter: Dan Isaac

Chairperson: Mr. Sebastian
 Definition

• Subjective
• Psychological experience or state
• Can be understood broadly as an interest
in sexual objects or activities
• Wish , need, or drive to seek out sexual
objects or to engage in sexual activities
(Regan, 2000)
 Historical perspective

• Lubbyati a Sanskrit word for “he desires”, later

translated to mean, “love”

• Egyptians earliest description for love is

translated into “a long desire”

(Ackerman, 1994).
 Components of sexual desire

• Drive

• Motivation

• Wish
Levine (2003)
Kaplan’s sexual response cycle
 Strength of the sex drive

• In men,
• Fantasize more
• Engage in sexual activity more
• More number of sexual partners
• Increased frequency of masturbation
• Less willing to forgo sexual activity
• Earlier onset
Baumeister et al. (2001)
 Variable proneness

• Women are more prone

to inhibition than men

• Negative consequences of activity

(Bancroft, 2002)
 Sexual concerns of women

• Emotion
• Commitment
• Attraction
• Respect
• Pregnancy
• Contraception
• Nothing of these is addressed in DSM system.
Tiefer (1995)
 HYPOACTIVE SEXUAL DESIRE
DISORDER

• Low sexual fantasies and desire for sexual

activity, which causes distress and is not due to
a medical condition, substance abuse, or
another Axis I disorder.

(American Psychiatric Association, 1994).

 DSM-IV-TR Diagnostic Criteria

• Persistently or recurrently deficient (or absent)

sexual fantasies and desire for sexual activity.
• The disturbance causes marked distress or
interpersonal difficulty.
• Not better accounted for by another Axis I
disorder (except another sexual dysfunction)
and is not due exclusively to the direct
physiological effects of a substance or a
general medical condition.
 ICD-10 criteria
F52.0 Lack or loss of sexual desire

• The general criteria for sexual dysfunction (F52)

must be met,

• Lack or loss of sexual desire,

• Lack of interest in initiating sexual activity either

with partner or as solitary masturbation
 Etiological factors

• Physiological Causes/Contributing Factors

• Pharmacological Causes

• Psychological Causes/Contributing Factors

 Physiological Causes

• General medical conditions

• specific medical conditions in females

• specific medical conditions in males

 Pharmacological Causes

• Chemotherapy drugs
• Anticonvulsants
• Antidepressants
• Antihypertensive agents
• Anti-ulcer drugs
• Birth control pills
• Neuroleptics
• Sedatives
www.newshe.com
 Psychological Causes

• Anger
• Depression
• Anxiety
• Stress reactions
• Post-traumatic stress
• Relationship difficulties
(Berman and Berman, 2001)
 Models of low Sexual Desire

• Kaplan’s intrapsychic conflict model (Kaplan,1979)

• Biological and hormonal model (Bancroft, 1983)
• Ego-analytic model (Apfelbaum, 1988)
• Object relations approach (Scharff, 1988)
• System theory (Verhulst & Heiman, 1988)
• Interactional models (Levine, 1984, 1987)
• Script theory (Rosen & Leiblum, 1988)
 Types

• Desire discrepancy

• Lifelong and generalized

• Acquired and generalized

• Acquired and situational.

Maurice(1999)
Hypoactive sexual desire disorder in
females.
• Four aspects of women’s sexuality

– Lower biological urge

– Context

– Represented psychologically

– Orgasm is not necessary

Basson(2000)
 Reason that sexually motivate

• Emotional intimacy
• Sense of well being
• Attractiveness
• Womanliness
• Wanting to share
• Partner as sexually attractive

Hill, Preston(1996), Klusmann(2002)

 Factors influencing processing of
stimuli in woman’s mind

• Psychological factors

• Contextual factors

• Biological factors

Hartmann(2002), Dennerstein(1999)
 Assessment

• Biopsychosocial

– Predisposing factors

– Precipitating and/or maintaining factors.

Balon(2005)
 Questionnaires
• The Brief Profile of Female Sexual Function
(Rust et.al, 2007)

• Sexual Function Questionnaire (SFQ28) (Quirk,

Haughie, and Symonds T,2005)

• Hypoactive Sexual Desire Disorder Screener

(HSDD) (Leiblum et al , 2006)

• Female Sexual Function Index (FSFI) (Rosen et al.,

2000)
 Treatment

• Nonhormonal /Hormonal Pharmacological

Treatment

• Psychological treatment
 Psychological treatment

• Cognitive behavioral therapy (CBT)

• Couple therapy
• Psychodynamic therapy
• Systemic therapy
• Relationship counseling
• Jack Anon’s PLISSIT

Reichman (1998)
Hypoactive sexual desire disorder in
males.

• Sexual desire manifests in three ways:

– Psychologically

– Behaviorally with partner

– Behaviorally with oneself

 Etiology

• Biological

• Psychological

• Social
 Biological

• Endocrine Abnormalities
• Medical Disorders
• Age-related Hypogonadal Syndrome:
(Andropause)
• Drugs
• Presence of Another Sexual or Gender Disorder
in a Patient or Partner.
 Psychological

• Intimacy Difficulty

• Psychiatric Disorders

• Madonna/Prostitute Syndrome

• Relationship Discord
 Psychosocial Issues

• Religious orthodoxy
• Anhedonic or obsessive-compulsive personality
traits
• Widower’s syndrome
• Lack of attraction to partner
 Assessment

• History

• Physical examination

• Laboratory examination.
 History

• Pattern of a Sexual Dysfunction: What to Ask

– Duration of difficulty
– Circumstances in which difficulty appears situational
– Description of difficulty
– Patient’s sex response cycle
– Partner’s sex response cycle
– Patient and partner’s reaction
– Motivation for treatment
 Physical examination

• Unrecognized disorder

• Hypoandrogen states

• Hypothyroidism

• Hypogonadism
 Laboratory examination.

• Testosterone (T)

• Prolactin (PRL).

• Diabetes

• Elevated lipids
 Questionnaires

• The sexual desire inventory (Spector et al 1996).

• Multiaxial diagnostic system for sexual

dysfunctions (MDSSD) (Schover, friedman, weiler, Heiman &
LoPiccolo, 1982)

• The Hubert Index of Sexual desire (Apt & Hurlbert,

1992; Hurlbert, 1993)

• International Index of Erectile Function (IIEF)

(Rosen et. al 1997) shorter version SHIM
 Treatment

• Psychotherapy

• Other treatments options

 Psychotherapy

• No controlled studies with a homogeneous

sample in which psychotherapy was the
mainstay of treatment
O’Carroll (1991)

• Orgasm consistency training, marital and sex

therapy
Hurlbert, (1993).
 Other treatments options

• Hormone therapy

• Pharmacological therapy

• Therapeutic devices
HYPERACTIVE SEXUAL DESIRE
DISORDER

• Characteristics

– Sex frequently
– several orgasms each day.
– Preoccupied with sexual feelings/thoughts
– Interferes with their functioning
– Creates problems in relationships
 Criteria

• DSM-IV-TR no diagnostic category (American Psychiatric

Association, 2000) ,
• The ICD-10 F52.7, excessive sexual drive, it simply
states:
• Both men and women may occasionally complain of
excessive sexual drive as a problem in its own right. No
research criteria are attempted for this category.
Researchers studying this category are recommended to
design their own criteria.
(World Health Organization, 1993)
 Kafka’s three criteria
A. Requires that, over a period of 6 months

B. cause clinically significant distress or

impairment in social, occupational, or other
important areas of functioning

C. do not occur exclusively during an episode of

another primary Axis I psychiatric condition,
psychoactive substance abuse, or a general
medical condition.
Kafka (2001)
 Etiology

• Blood concentrations of gonadal hormones

• Medical conditions

• Incentive motivation/learning hypothesis

 Risks associated

• Financial ruin
• Unemployment
• Contagion with sexually transmitted diseases
• Penal pursuit
• loss of social esteem
 Treatment

• No trial where patients suffering from it have

been found.

• Reducing androgen concentrations

• Reduce the incentive value

• Blocking the sexual reward

 Conclusion

• Humankind has still great difficulty in

understanding concept of sexual desire, and
even greater difficulty attempting to control it.

• Evident throughout the research efforts, is

humankind’s fear of sexual desire, and the
subsequent attempts to regulate and moralize it.
Thank you