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Opinion: Sexual Dysfunction Matters

Desire and arousal disorders require the biopharmaceutical industry’s attention.

By | August 19, 2013

FLICKR, JASON SCHLACHETA female commentator on a major cable news channel recently told viewers that the way for men to turn women “on” is to “load the dishwasher.” If it were that simple, therapists would have a great track record of treating low female libido. The dirty secret is they don't. And even more surprising secrets exist in the published research. For example, in 2011, a national survey determined that men who do domestic chores, the kind traditionally performed by women, have significantly less sex than men who don’t, not more.

Though pharmaceutical companies are commonly criticized for “medicalizing” sexual dysfunction, this is not the case. Sexual functioning levels are reduced, and sexual distress is increased among women with sexual desire or arousal problems who have reported a sexual complaint to a doctor—even those who reported otherwise-normal levels of marital satisfaction. Problems with desire and arousal are even recognized by the American Psychiatric Association (APA), which combines the two within sexual interest-arousal disorder (SI-AD). According to the APA, low desire is a problem worth treating when it causes distress and reduces the quality of a woman's life. 

People diagnosed with hypoactive sexual desire disorder (HSDD) experience little to no desire for sex, and as a result, significant distress or interpersonal difficulties. Although under-diagnosed, HSDD is highly prevalent in the U.S. among both pre- and postmenopausal women. Reviewing results from more than 30,000 American women surveyed in 2008, a team led by a gynecologist Jan Leslie Shifren found that distressing low desire affects around one in every 10 women. HSDD distresses men, too.

APA recognizes two kinds of desire and arousal disorders: generalized and situational. For example, if a woman feels no desire for her husband, but hankers for a hunk at the office, that’s situational. No one claims that desire and arousal disorders of the situational variety are medical problems. However, all too often sexual disorders are of the generalized type, rendering affected men and women sexually inert in all circumstances and with all potential partners. This is what the specialty of sexual medicine seeks to treat.    

Imaging studies have shown that certain areas of the brain appear to function abnormally in women and men with HSDD. The same areas have been better studied in animals, especially rodents, and found to be markedly affected by an imbalance of neurotransmitters. The brain is central to sexual function; neurotransmitters in the brain, particularly dopamine, norepinephrine, and serotonin, play key roles in regulating sexual desire. Diminished function of the dopamine system, which raises sexual desire and excitement, and the norepinephrine system, which stimulates arousal and orgasm, have been well documented to lead to problems with desire and sexual activity. An overly abundant supply of serotonin in the brain almost invariably inhibits desire and arousal and delays orgasm.

There are no FDA-approved treatments for generalized sexual dysfunction. Various hormonal approaches have been proposed, but no specific hormonal deficiency has been found in women with HSDD. Because of this, hormonal treatments seem at best inappropriate, and worse, to raise a specter of long-term safety issues. Neurotransmitter modulators might bear fruit, but unsurprisingly, single-component drugs have failed in the past.

We need to re-evaluate our approach to low desire and arousal, or we will never properly understand them enough to develop treatments. When sexual dysfunction is swept under the rug or considered strictly situational, despite a lack of data to support this notion, many will continue to feel uncomfortable seeking help, and therefore suffer in silence. 

Robert Pyke is the chief medical officer at S1 Biopharma, a company working to develop treatments for hypoactive sexual desire disorder and related sexual dysfunctions.

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Comments

Avatar of: Neurona

Neurona

Posts: 33

August 19, 2013

Americans, especially, are stressed out, overworked, and exhausted.  Women are running the home AND working, sometimes 2 jobs.  On top of it, we are fed a marketing line that we should always be sexy, up to standards that require Photoshop to attain.  A socioeconomic fix is what's needed, not a pharma fix. 

Avatar of: LeeH

LeeH

Posts: 31

August 19, 2013

I believe there is a world of difference between the HSDD condition and relationship building that hightens a sexual relationship between to people with no pathology, a far more common occurance.  To try to equate the two is misdirected.

Avatar of: klem

klem

Posts: 1

August 19, 2013

In the 1970s, psychologist John Money first proposed that androgens were key in adequate sexual arousal for both men and women. He arrived at this hypothesis as a result of his work with hypogonal men who with low libido and female-to-male transsexuals who experienced increased libido with testosterone supplementation. There is a growing body of evidence that testosterone treatment may be safe and effective for HSDD.

Avatar of: Brian Hanley

Brian Hanley

Posts: 24

August 19, 2013

The species evolved with all this. At the end of and after child-bearing years, there is no purpose to female sexuality to speak of. There is little purpose to male sexuality either, except with younger females. 

But older males can have progeny with young females, and older males may have the resources to be attractive as a mate. 

Female sexuality cannot be divorced from the result of sex, which is - for women - children. 

So from a scientific perspective, there is no reason to think that low libido in older women is dysfunctional. Quite the reverse is true. What is dysfunctional in older women is a high libido - at least from most ways of looking at evolution. 

There is the "outlet argument" which gains some credence from certain aboriginal sex patterns. For instance, in an eskimo community an elderly woman with no teeth was very popular with young men. So it is arguable that for communities with young men going stir-crazy on long winter nights that older women wanting sex with them is functional. 

But mostly, it's not. 

Avatar of: ds sheriff

ds sheriff

Posts: 4

August 19, 2013

SIAD and HSDD are considered as abnormal response to sexual desire and arousal. Hormones and brain centres are considered to hold the keys to understand and treat such disorders. It is not just specific alterations in human physiology or human sexuality. It is a complex phenomena which two compatible persons get involved and experience. It is the chemistry between two human beings how they adopt, adjust and apply their mind and body to attaining sexual satisfaction. Many a time a hug or stress releasing talk or physical touch do knidle such desires. It is a communication gap or pressing problems or situations that hamper coming together of two people to experience total fulfilment of their sexual urges. It is the people concerned who make their sexual life interesting. Feelings that are kept suppressed because of social status of women or the pride of men need to be discussed for the fire in the blood needs only a flicker of arousal for every indivdual has his or her individuality in sexual life.

Avatar of: Narcelo

Narcelo

Posts: 1

August 20, 2013

Some nutritionists have attempted to prove that there are some foods that can stimulate sexual desire and maintain good sexual activities. Therefore what is the best option to follow?

Avatar of: MCFS

MCFS

Posts: 1

August 26, 2013

Thank for raising awareness around low sexual desire in women.

Unfortunately there is a lot of ignorance regarding the potential medical explanations for low libido and it has lead to increased confusion and frustration for many couples. In our work treating female sexual dysfunction, we often meet women who have tried many behavioral techniques for their low libido and have not seen a difference because the issue is related to hormones.

Fortunately, with more articles like these there will be enhanced understanding of the various factors at play in low libido, and not just simple "just do it" or "be a better husband" type of messages. 

Rachel Hercman, LCSW

Medical Center for Female Sexuality, NYC

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