What is the approach to evaluating hypoactive sexual desire disorder (HSDD) in a female with normal hormonal levels?

From the Guidelines

To assess low sexual drive in a female with normal hormonal levels, a comprehensive biopsychosocial evaluation should be conducted, incorporating a detailed medical history, physical examination, and screening for depression and anxiety using validated tools like the PHQ-9 or GAD-7, as well as utilizing the Female Sexual Function Index (FSFI) questionnaire to provide an objective measurement of sexual function across multiple domains. This approach is supported by the most recent and highest quality study available, which emphasizes the importance of a multidimensional assessment in understanding and addressing sexual dysfunction in women 1.

Key Components of the Evaluation

• A detailed medical history focusing on chronic conditions, medications (particularly antidepressants, antihypertensives, and hormonal contraceptives), and relationship factors
• Physical examination to assess for signs of underlying conditions that might contribute to sexual dysfunction
• Screening for depression and anxiety using validated tools
• Evaluation of relationship dynamics, stress levels, and past sexual experiences that might influence current sexual function
• Utilization of the Female Sexual Function Index (FSFI) questionnaire for objective measurement of sexual function

Considerations for Management

• Treatment should address identified causes, considering cognitive behavioral therapy for psychological factors, couples therapy for relationship issues, or mindfulness-based approaches for stress
• If medication side effects are suspected, discussing potential alternatives with the prescribing physician is crucial
• The complex interplay of biological, psychological, and social factors contributing to low sexual desire necessitates a multifaceted management approach, as highlighted in studies focusing on sexual function in various contexts, including cancer survivors 1.

Prioritizing Patient-Centered Care

Given the sensitivity and personal nature of sexual health issues, initiating open and respectful discussions with patients about their sexual function and concerns is essential, as emphasized by guidelines for assessing and managing sexual dysfunction in women 1. This patient-centered approach ensures that care is tailored to the individual's needs, promoting better outcomes in terms of morbidity, mortality, and quality of life.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Assessing Low Sexual Drive in Females with Normal Hormonal Levels

To assess low sexual drive in a female who has drawn normal hormonal levels, several factors should be considered:

• The complex physiologic and psychological components of female sexual dysfunction, which require a detailed screening, history, and physical examination 2
• The potential impact of depression and antidepressant medication on sexual function, as depression is frequently associated with impairments in several areas, including sexual dysfunction 3, 4
• The availability of pharmacologic options for treating hypoactive sexual desire disorder (HSDD), including flibanserin and bremelanotide, which are approved by the Food and Drug Administration for generalized acquired HSDD in premenopausal women 5
• The importance of a multimodal approach to treatment, including nonpharmacologic interventions such as psychotherapy and lifestyle adjustments, alongside pharmacologic options 5

Key Considerations

When assessing low sexual drive in females with normal hormonal levels, the following should be considered:

• The patient's medical and psychiatric history, including any history of depression or anxiety disorders
• The patient's sexual history, including any history of sexual trauma or abuse
• The patient's relationship status and any issues related to their sexual partner
• The patient's lifestyle and any factors that may be contributing to their low sexual drive, such as stress or fatigue
• The potential benefits and risks of pharmacologic treatment options, including flibanserin and bremelanotide 5

Treatment Options

Treatment options for low sexual drive in females with normal hormonal levels may include:

• Pharmacologic options, such as flibanserin and bremelanotide, which are approved by the Food and Drug Administration for generalized acquired HSDD in premenopausal women 5
• Nonpharmacologic interventions, such as psychotherapy and lifestyle adjustments, which can help address underlying issues contributing to low sexual drive 5
• Alternative treatments, such as bupropion, which has been shown to have a lower impact on sexual functioning compared to other antidepressants 3, 6