Hypoactive Sexual Desire Disorder (Loss of Libido)

Question 1

Who is HSDD more common in, men or women?

Answer 1

Women

Men - 1-20%

Women 26-43%

Question 2

What are some important questions to ask?

Answer 2

• Gradual or sudden onset?
• Alcohol intake?
• Other health problems? (Diabetes)
• What medications are they taking?
• Mental health problems?
• If male, loss of performance?
• If female, menopause?

Question 3

What can cause HSDD?

Answer 3

• Depression (most common)
• Stress
• Medications - e.g. antihypertensives,antidepressants.
• Post-natal
• Chronic alcohol intake and cirrhosis
• Erectile dysfunction
• Dyspareunia
• Marriage problems

Question 4

What investigations should you do?

Answer 4

• Screen for depression
• FBC
• LFTs
• TFTs
• FSH/LH
• Prolactin
• Testosterone
• If erectile dysfunction - fasting glucose & Cholesterol

Question 5

What hormones excite sexual drive?

Answer 5

• Sex hormones
• Dopamine

Question 6

What hormones supress sexual drive?

Answer 6

• Serotonin
• Prolactin

Question 7

How do you manage HSDD?

Answer 7

• If depression treat it.
• Consider counselling if relationship or stress.
• Reduce stress.
• Address drugs that may be causing it.
• Menopausal or Ovarian Failure - consider HRT but weigh up risks vs benefits.
• Androgen patches - are controversial - don’t use.
• Bupropion (yes same as smoking cessation) - increases dopamine in the brain.
  
  • Not to be used in epilepsy
• Tibolone - increased risk of DVT, breast cancer and strokes.

Question 8

A 50 year old female presents with concerns related to reduced libido. This has been causing problems with her husband and she feels rather down.

In her past history she has had ovarian failure associated with a hysterectomy three years ago and is being treated with oestradiol 2mg daily.

Which of the following would be the most appropriate treatment for this patient?

• Add fluoxetine
• Add norethisterone
• Add testosterone patch
• Counselling & lifestyle advice
• Optimise oestrogen replacement

Answer 8

Optimise oestrogen replacement

• Depression may need to be treated but antidepressants can also cause hypoactive sexual desire.
• Progrestogens are not required in hysterectomised women.
• Testosterone patches are licenced but not used by GPs.