What happens when your desire to have sex isn’t there — but you want it to be? Some women experiencing this low to no sex drive may be diagnosed with hyposexual desire disorder, or HSDD.
It’s important to note that HSDD is no longer an official diagnosis, as the Diagnostic and Statistical Manual of Mental Disorders removed HSDD from its fifth and most recent edition in 2013, replacing it with the more all-encompassing umbrella term female sexual interest/arousal disorder (FSIAD).
Still, the HSDD term has stuck around and is still used by many sex therapists.
“Drug companies still use HSDD, and some therapists still use the term too. I prefer to call it ‘diminished desire,’ in that your desire is lower than you like,” says Laurie Mintz, sexual psychologist and author of the book Becoming Cliterate: Why Orgasm Equality Matters — and How to Get It. “The difference between HSDD and FSIAD is that … with HSDD, you say you have ‘lost desire.’ With FSIAD, you also have trouble getting aroused.”
Previously, people who were diagnosed with HSDD had to meet several conditions, according to Jordan Rullo, clinical psychologist and certified sex therapist at the women’s health app Flo. They must have little to no sexual fantasy or desire for sexual activities for at least six months as well as marked distress about this lack of desire. In addition, this lack of desire can’t be exclusively caused by a medical issue (such as menopause), an issue in one’s relationship or a psychological issue (like depression).
“Typically, women with HSDD report that they have no interest in having sex, either solo or with a partner, and it bothers them,” she explains. “Women in my office with HSDD often say they ‘want to want to have sex.’”
It’s this piece — that the lack of interest is bothersome — that distinguishes HSDD (and FSIAD, for that matter) from asexuality. People who are asexual do not have sexual desire, or have very low sexual desire — and wouldn’t be diagnosed with something like HSDD, because they’ve always had that level of desire.
Still, HSDD is complicated because there’s no “right” amount of desire. “When people say they have diminished desire, they often mean they have lower desire than their partner, or than their former self,” says Mintz.
What are some reasons for low desire?
Whether someone is concerned that they have HSDD or not, there are plenty of reasons why someone might experience low sexual desire, says sex therapist Deb Laino, author of The Missing Link: A Fusion of Sexuality, Psychology, Lifespan Development and You. These can range from health issues, such as hormonal imbalances or the use of selective serotonin reuptake inhibitors (SSRIs), a class of medications prescribed to treat depression. However, diminished desire may also be the result of a traumatic experience around sex, which can make you no longer interested in engaging with that part of yourself.
In order to get someone back to a level of sexual desire they’re more comfortable with, one must look at a holistic image of their health, lifestyle and relationship. That might mean testing one’s hormones to see if there is an issue, or seeking a sex therapist who can help them navigate emotions around sex.
Mintz says it’s also important to note that sometimes when people believe they have no desire, they really mean they do not have spontaneous desire — “either in general or in the presence of their partner.” Spontaneous desire means feeling desire without much external stimuli — like, say, if your partner just walked into the room. Responsive desire, on the other hand, refers to feeling desire only after you’ve already engaged in a sexual modality, such as when you and your partner begin kissing and touching. While spontaneous desire is more common early in a relationship, Mintz says, that “limerence phase” is actually a biochemical event that lasts only “six months to two years on average.”
“It’s normative for one’s desire to decrease both with age and the length of a relationship,” Mintz says. “A lot of people don’t know that, and they say, ‘Oh, my gosh, what’s wrong with me? What’s wrong with my relationship?’ But if more people knew this, they would be less upset.”
If more people knew that there are two kinds of desire, they may put less pressure on themselves, explains Mintz.
“Responsive desire is an equally legitimate form of desire,” she says. “It’s when you say, ‘I’m open to the idea of sex, in my mind, even though my body might not be, because I know it will be good when it gets going.’ If people knew that, they could schedule sexual encounters. As I say to my clients, ‘Have sex to get horny, rather than be horny to have sex. Reverse the equation.’ For many women, the actual desire follows the sex, rather than the reverse. A lot of people who do say they have diminished desire may be lacking knowledge about how actual desire works.”