Hypoactive Sexual Desire Disorder: Am I Missing Something?
Posted by Dr. Vollmer on June 20, 2010
‘ Hypoactive sexual desire disorder’, I pause. Now, it is a disorder, not clear where it is written as such, for a woman not to want to have sex, at the same time that DSM-5 is floating the possibility of a hypersexuality disorder https://shirahvollmermd.wordpress.com/2010/02/15/hypersexuality-another-are-you-kidding-dsm-5/ . Is there some meter for sexual desire? Is sexual desire directly linked to the chemicals of our brain? What ever happened to the connection between a satisfying interpersonal relationship leading to sexual desire and the converse also true? Perhaps the disorder is not in the woman, but in the relationship. Duh.
Now, let us suppose that a woman, no matter what relationship she is in complains of a low libido. One could argue that chemical assistance might be in order. Boehringer Ingelheim, a German pharmaceutical company, has a medication (flibanserin) which although originally designed as an antidepressant, is now geared to elevate sexual desire in premenopausal women who are distressed by diminished libidos. http://www.nytimes.com/2010/06/19/business/19sexpill.html?scp=1&sq=boehringer%20fda&st=cse
I would happily prescribe a drug to a woman who could experience more sexual pleasure, given that the benefits outweigh the risks. I salute any pharmaceutical company that is focused on improving women’s mental and physical health. I support their efforts and I look forward to the FDA approval. My issue is not with the medication or with the drug company, but with the diagnosis. If the medication enhances the quality of life for a woman, why do we, as a society, need to link a drug to a diagnosis? Maybe the drug, like caffeine, helps people by altering the chemicals in their brain; the fact that the drug helps does not necessarily mean there is a disorder.
Insurance companies require a diagnosis for reimbursement. Is this the problem? Perhaps, but not the only problem. Doctors tend to want to treat disease. As a group they are not comfortable with promoting wellness, either through education or through pharmaceuticals. The culture of medicine needs to change. Baldness is not a disease, and yet doctors prescribe medications to help. Treatment must have a broader meaning beyond treating disease. As physicians, we need to treat discomfort; we need to openly accept that we want to help people enjoy more pleasure from their lives. A woman who has a low libido is not ill, but with some help, she could have a lot more fun.
Shirah Vollmer MD 
Shelly said
What is the definition of an illness? How incapacitated must one be to be considered “sick”? True, baldness is not an illness, but the effects of being bald may hinder someone’s sense of self so badly that they end up depressed. What about infertility? Is that any illness? Should insurance companies pay for treatments? Why should they pay for birth control pills (prevention of pregnancy) when they question the need to pay for low-libido pills (to initiate a pregnancy)?
I understand your point–that low libido is not considered a medical illness, but the effects of low libido may be. It makes a woman feel terrible about herself, and therefore is as much an illness as depression is.
Dr. Vollmer said
As usual you ask the most important question. Illness, at least a mental illness, is defined by an impairment in occupational and social functioning. The example of baldness highlights my issue. Treating baldness might prevent a mental illness, but it might just make someone who feels good, feel better. Infertility is not an illness, but it can be a problem. Insurance is a complicated matter. Some people think that insurance should only be used for matters which are unpredictable, and hence most treatments would not be covered (similar to car insurance). Yes, paying for oral contraceptives is controversial in the insurance world.
Yes, my point is that we, as physicians, should embrace prevention of mental illness by working to enhance people’s lives. How do we chart that? The culture needs to change.