The diagnosis of HSD is not difficult if the clinician asks directly about desire or interest for sexual activity. Most patients identify with ease a change in their usual pattern, and this is the way in which the condition is identified most of the time in clinical practice. Sometimes, it is necessary to investigate the indicators of sexual desire, which, although not as direct as the expression of desire, are often good clinical indicators. Table 13.5 shows a list of clinical indicators of sexual desire.
The question of how much is too little has not been answered with enough precision. However, some re ports in the literature give some light to this. In a group of non-dysfunctional couples, LoPiccolo and Friedman reported that the majority of the participants both desired and had sexual activity between once and four times a week . In a research setting, Schiavi  suggested a criteria of sexual activity occurring less than once every two weeks, for persons 55 years or younger, suggests HSD.
Some patients present themselves as having low sexual desire, which in fact is a result of another sexual dysfunction. Erectile dysfunction is sometimes confused by the patient as a sign of diminished desire. Likewise, the avoidance pattern that follows the frustration generated by a persistent dysfunction, like severe premature ejaculation or erectile dysfunction, can also be reported as absence of desire. These clinical situations demand a careful evaluation from the clinician before arriving at a clinical diagnosis.
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