In contrast with other conditions related to the sexual life, the key clinical determinants of this diagnosis are not as concrete and readily identified as erection or ejaculation for instance, in the case of HSD these clinical features refer to a variety of expressions of sexual desire, since the occurrence of sexual desire is an internal and subjective experience. Because of this, HSD has been historically either not identified , or erroneously diagnosed and presented (and treated) as other sexual dysfunctions like erectile dysfunction .
Hypoactive sexual desire was first defined as a clinical entity in 1977 , and recognized as a valid clinical diagnosis with the publication of the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM III) in 1980 . In recent publications, the importance of this condition has been highlighted [2,5].
The DSM IV, in its current edition, defines HSD disorder as persistently or recurrently deficient (or absent) sexual fantasy and desire for sexual activity, leading to marked distress or interpersonal difficulty . However, since the DSM IV is a psychiatric classification, its definition excludes HSD when it is caused by another medical disorder, or even another sexual dysfunction. There is some discussion in the literature as to this requirement, as the clinical practice illustrates, that the co-existence of HSD disorder with other sexual dysfunctions such as erectile dysfunction is rather common , and the management of the combined conditions often requires specific clinical decisions and actions.
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