A biopsychosocial approach to hypoactive sexual desire disorder

Low libido is common among women, but it meets criteria for hypoactive sexual desire disorder (HSDD) only when it causes clinically significant distress, according to Holly N. Thomas, MD, MS, who addressed the management of HSDD at The Menopause Society 2026 Annual Meeting. A patient who reported low desire but was not particularly bothered by it would not necessarily qualify for the diagnosis.¹

Survey research showed that reports of low libido were frequent, particularly among midlife and older women, yet women are less likely to bring these concerns to their health care professionals. As a result, identification depends on clinicians, including those in general internal medicine, proactively asking about sexual concerns.²

“It’s important for health care providers, including general internal medicine practitioners, to ask their patients about any problems with sexual function, including low libido, so that we can identify these patients and talk to them about treatment options,” said Thomas, an associate professor of medicine at the University of Pittsburgh Medical Center in Pennsylvania.

Distinguishing HSDD from low desire driven by other conditions requires a holistic evaluation, because many factors could affect a woman’s libido. Menopause practitioners often consider hormones first, but research has shown that a broad range of factors influenced libido and other aspects of sexual function, according to Thomas. She advises a biopsychosocial approach to clinical evaluation that addressed 4 domains: medical, relational, psychological, and sociocultural.²

The medical history should capture factors with potential effects on sexual function, such as prior surgeries and diagnoses including diabetes and hypertension, both of which are known to affect sexual function in women. Thomas recommends reviewing these elements as the first domain of the evaluation.

Because sexual activity occurs within a partnered romantic relationship for many women, the evaluation should also assess the patient’s current relationship. Relevant questions include whether there is discord that could affect libido and whether the partner is experiencing sexual problems of their own that could affect the sexual function of both partners.

Mood disorders and medications also warrant review.

“Are there mood disorders present like depression or anxiety which can contribute to low libido, or are there medications that the patient is taking that could potentially have negative impacts on libido?” Thomas said. Antidepressants and opioids are among the common culprits she identifies, and she emphasizes asking patients about them directly.

Clinicians should also consider the patient’s sociocultural context, including whether she comes from a culture in which women’s sexuality is looked down upon and whether that background has negatively affected her relationship with her own sexuality. Thomas describes this sociocultural component as the final domain of the holistic evaluation.

This level of assessment takes time, Thomas notes, and clinicians should schedule visits long enough to complete a thorough, multidomain evaluation when a patient presents with concerns about low libido.

References

1. Shifren JL, Monz BU, Russo PA, et al. Sexual problems and distress in United States women: prevalence and correlates. Obstet Gynecol. 2008;112(5):970-978. doi:10.1097/AOG.0b013e3181898cdb
2. Clayton AH, Goldstein I, Kim NN, et al. The International Society for the Study of Women’s Sexual Health process of care for management of hypoactive sexual desire disorder in women. Mayo Clin Proc. 2018;93(4):467-487. doi:10.1016/j.mayocp.2017.11.002