Diminished Libido, Its Manifestations and Definitions of Hypoactive Sexual Desire Disorder

Abstract

The article deals with clinical manifestations of diminished libido as well as definitions of hypoactive sexual desire disorder (HSDD) in the International Classification of Diseases, 10th Revision (ICD-10), Diagnostic and Statistical Manual of Mental Disorders, Fourth and Fifth Editions (DSM-4 and DSM-5) (USA). Its corresponding code in ICD-10 is F52.0 (“Lack or loss of sexual desire”), which is common for both men and women. DSM-4 has code 302.71 (“Hypoactive Sexual Desire Disorder”), which is common for persons of both sexes too. The point to note is that the above classification considers the presence of distress or difficulties in interpersonal communication, caused by hyposexuality, as one of indicators for diagnosing this disorder. DSM-5 uses diagnosis “Male Hypoactive Sexual Desire Disorder” (code 302.71), whereas for revealing this disorder in women general diagnosis “Female Sexual Interest/Arousal Disorder” (code 302.72) is used, since in compliance with the opinion, present in the above guide, women are characterized by difficulties in differentiation and a frequent comorbidity of disorders of sexual interest and sexual excitement. Also, attention is called to the fact of substitution of the term “sexual desire” with the term “sexual interest”, thereby giving some psychological tint to the first part of the diagnosis and reducing its biological background. Both DSM-5 codes (for men and for women) also provide for a diagnostic criterion, according to which hypoactive sexual manifestations cause a clinically significant distress. The author also informs about existence of an autonomous classification of female sexual dysfunctions by two international panels of experts in sexual medicine (Nomenclature Committee of the International Society for the Study of Women’s Sexual Health and the International Consultation in Sexual Medicine), who believe that preservation of the separate diagnosis “Hypoactive sexual desire disorder” for women is reasonable. It is reported that ICD-11 will use diagnosis “Hypoactive sexual desire dysfunction” not only for men, but for women too. The given data demonstrate scientific substantiation for such a decision. Attention is called to the fact that the above classification has fully absolutized the subjective perception of hyposexuality. For example, it is reported that the proposed diagnostic guide takes aim at the absence of any norms for sexual activity. It is suggested to regard as “satisfactory” the sexual activity, which satisfies the given person. If the individual is satisfied with his/her sexual activity, the possibility of diagnosing his/her sexual dysfunction is excluded at once. Validity of such an approach is discussed. Besides the described hypoactive sexual manifestations, the article also lists the clinical phenomena, which are associated with the above manifestations and accompany them.