Ask a Sex Therapist : Is My Sex Drive Low Because I Just Had a Baby, or Is It HSDD?
Sex should be fun, but it can also be complicated. Welcome to Sexual Resolution, a biweekly column by sex therapist Vanessa Marin answering your most confidential questions to help you achieve a healthy, joyful sex life. Here, she answers a question about hypoactive sexual desire disorder.
DEAR VANESSA: I had my first baby two years ago. My partner and I were prepared for the fact that having a baby would bring some major changes to all aspects of our lives, including our sex life, so we went into this eyes wide open. However, my sex drive vanished in my third trimester, and it has yet to reappear. Although I’m trying to be patient with myself, I’m also finding that my anxiety is building the more time goes on without me feeling any desire for sex. My partner is getting increasingly bummed, too. Is it possible that something else is going on other than the usual post-baby sex drive dip? A friend of mine was diagnosed with Hypoactive Sexual Desire Disorder; could I have that too? - Wanting To Want Again, 29
DEAR WTWA: I appreciate that you went into your pregnancy aware that it would have a major impact on your sex life, and willing to be patient with yourself as your body navigated all of the changes that pregnancy and childbirth can bring. It’s actually quite rare that people acknowledge these dynamics.
I wish I had an easy answer for you about what may be going on with your sex drive, but libido is a very complex and layered issue. Doctors and researchers have historically struggled with identifying and defining problems related to sex drive, especially with women. The most recent attempt to classify low sex drive is Hypoactive Sexual Desire Disorder.
What is HSDD?
According to the Mayo Clinic, Hypoactive Sexual Desire Disorder (HSDD) is defined as: “(1) lack of motivation for sexual activity as manifested by either reduced or absent spontaneous desire (sexual thoughts or fantasies) or reduced or absent responsive desire to erotic cues and stimulation or inability to maintain desire or interest through sexual activity or (2) loss of desire to initiate or participate in sexual activity, including behavioral responses such as avoidance of situations that could lead to sexual activity, that is, not secondary to sexual pain disorders, and is combined with clinically significant personal distress that includes frustration, grief, incompetence, loss, sadness, sorrow, or worry.”
It seems like a pretty long definition, but all that it really says is that a person doesn’t want to have sex, doesn’t think about it, and is bothered by their low sex drive.
There are a number of different categories of HSDD. It can be general, meaning that the person has very little desire overall, or situational, meaning that the person feels sexual desire, but not for their partner. It can also be lifelong, meaning that the person has always experienced low desire, or acquired, meaning that it developed at a certain period in a person’s life.
How do I know if I have hypoactive sexual desire disorder?
The Mayo Clinic notes that there isn’t a great standardized method for screening for HSDD. One of the main methods for HSDD is this five-question survey (all responses are to be either “yes” or “no”):
In the past, was your level of sexual desire or interest good and satisfying to you?
Has there been a decrease in your level of sexual desire or interest?
Are you bothered by your decreased level of sexual desire or interest?
Would you like your level of sexual desire or interest to increase?
Now, please check all the following factors that you feel may be contributing to your current decrease in sexual desire or interest:
1. An operation, depression, injuries, or other medical conditions
2. Medications, drugs, or alcohol you are currently taking
3. Pregnancy, recent childbirth, menopausal symptoms
4. Other sexual issues you may be having (pain, decreased arousal, or orgasms)
5. Your partner's sexual problems
6. Dissatisfaction with your relationship or partner
7. Stress or fatigue
Again, this seems lengthy, but it really only boils down to a few dynamics: having a low sex drive and being bothered by it. Approximately 10 percent of women experience HSDD, but it’s important to note that not all women with low sex drive inherently have HSDD. As I mentioned above, sex drive is a complex issue that can be affected by a number of different factors. In my private practice, I’ve developed a Five Foundation model to categorize the most common factors:
Physical: There are a number of medical conditions that can cause low sex drive. The Mayo Clinic lists “arthritis, cancer, diabetes, high blood pressure, coronary artery disease and neurological diseases.” It also notes that medications for anxiety and depression can lower sex drive, as can drugs, alcohol, smoking, chronic fatigue, and hormonal changes.
Mental: Negative beliefs about sex or a lack of information about sex can lower your sex drive.
Emotional: Anxiety, depression, stress, low self-esteem, a poor relationship with your body can all decrease the desire for sex.
Relational: Relationship problems and communication challenges can make you feel less desire for your partner.
Sensual: Includes pain during sex, past sexual abuse, and unpleasurable sex.
I encourage you to go through this list and see if any of these factors may be affecting your current relationship with your sex drive.
How is HSDD treated?
Since low sex drive is such a complex issue, treating it can be equally complex. According to a recent Mayo Clinic review, here are some of the common treatments for HSDD:
Psychoeducation: A type of education that gives people proper information about sex and sexual desire.
Sensate focus: A sex therapy exercise where partners are instructed to spend more time touching each other, without the explicit goal of it leading to more desire, or even to sex.
Cognitive Behavioral Therapy: Therapy that focuses on both altering thought processes about sex drive, and providing specific behavioral exercises.
Mindfulness and meditation: Attempting to focus on your own experience and trying to carve out time to quiet your mind.
Medication: Includes Flibanserin (currently the only FDA approved medication for sexual desire disorders), Testosterone, and Bupropion (the anti-depressant commonly known as Wellbutrin).
It’s also important to know that there’s a lot of controversy around HSDD. Definitions of what comprises “healthy” sex drive are culturally-defined. Your sexual desire doesn’t necessarily impact your health or well-being, and there are plenty of people who are perfectly content with having low or no desire. Many therapists and researchers believe that HSDD is overly simplistic, and ends up putting too much emphasis on medication to treat sex drive.
If you’re curious about HSDD, you can make an appointment with your doctor to talk about your relationship with your sex drive and start running some tests to rule out medical causes. I also highly recommend seeking out a sex therapist, so you can talk about the mental and emotional impacts, and develop a concrete game plan for getting your sex drive back to where you want it to be. Wishing you the best of luck.
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Vanessa Marin is a licensed sex therapist based in Los Angeles. You can find her on Twitter, Instagram, and her website.
Originally Appeared on Allure
