Hypoactive Sexual Desire Disorder

Hypoactive Sexual Desire Disorder (HSDD) in premenopausal women. Hypoactive Sexual Desire Disorder has been estimated to occur in up to one-third of adult women, but most estimates are much lower.

It is rather vaguely defined as 'the persistent or recurrent deficiency or absence of sexual fantasies and desire for sexual activity with marked distress or interpersonal difficulty not otherwise accounted for by a general medical or psychiatric condition[1]. It may be primary or secondary, lifelong or acquired, or generalized or situational'.

Well, you might think that this is a rather problematic disorder, nut there are several problems: the diagnostic category of Hypoactive Sexual Desire Disorder has been criticized on several grounds. It is poorly defined and may have more of a social function than a medical one. The syndrome itself may even be not one, but a diverse group of conditions and may have many causes. The requirement that it causes distress may be problematic. The parameters of normality are not yet well understood. Hypoactive Sexual Desire Disorder has been accused of medicalising sexuality and pathologising normal variations.

So, while Hypoactive Sexual Desire Disorder may not even be an existing disorder, some companies are vying to bring 'a solution' to the market.

Vyleesi (bremelanotide) was approved by the FDA following just small two clinical trials. It has been hyped as 'female Viagra'. It is no such thing, bacause Viagra is used to treat erectile dysfunction in men who have sexual desire, but are unable to perform. Vyleesi is used to treat women who don’t have sexual desire, but want to. That may be a real problem for some women, but the new drug is far from an ideal solution. It’s not very effective and is problematic in other ways. A stunning 40 percent of test persons reported nausea. It cannot be used with alcohol. It may cost $50-75 per dose, with an anticipated average of four doses per month[2]. Its long-term effects have not even been studied.

Vyleesi needs to be injected about 45 minutes before their sexual activities. So patients have to plan for injection 45 minutes before sex, and then it only increases desire without increasing the number of satisfying sexual events. How often can women plan sex 45 minutes ahead? What about spontaneity?

[1] Goldstein et al: Hypoactive Sexual Desire Disorder in Mayo Clinic Proceedings - 2017. See here.
[2] Osborne: Amag’s Vyleesi cleared in HSDD; ‘next chapter’ begins in BioWorld. See here.