HSDD is a disorder characterized by absent or low desire for sexual activity that is associated with interpersonal difficulty or distress (ApA, 2000). A distinction is made between receptive and proceptive sexual behaviors, with a lack of proceptive behavior most indicative of true low sexual desire (Pridal & LoPiccolo, 2000). HSDD affects both men and women, and it is the most common primary diagnosis in cases of sexual dysfunction. Segraves and Segraves (1991) conducted a large pharmaceutical study for sexual disorders and found that 19% of clients with a primary diagnosis of HSDD were male. Prevalence estimates for community samples indicate a rate of 15% for males (Rosen & Leiblum, 1995).
The three major etiological factors for low sexual desire that have been proposed are hormonal problems, affective-cognitive models, and relationship dynamic theories. Although evidence of hormonal influence on sexual desire in females is inconsistent, research continually shows a relationship between androgens and sexual desire in males (Beck, 1995). Androgens, particularly testosterone, seem to be essential for normal levels of sexual desire in males (Bancroft, 1988). However, testosterone deficiency does not account for all cases of HSDD in males (Schover & LoPic-colo, 1982).
Theories of excessive negative affect may account for some of these non-physiological cases. Kaplan's (1979) theory of intrapsychic anxiety and anger as determinants of low desire has also received empirical support. Studies indicate that increased anger is associated with diminished desire and penile tumescence in men, while anxiety is related to decreased subjective arousal but is not related to tumescence (Beck & Bozman, 1995; Bozman & Beck, 1991).
Relationship dynamic explanations for low drive in men have stressed the adaptive value of low desire for the maintenance of relationship equilibrium (LoPiccolo & Friedman, 1988; Verhulst & Heimen, 1988). Low desire may serve an effective function within the habitual dynamics of the marital relationship. For example, low drive is cited as being a passive-aggressive way for a man to maintain a position of some power and control or emotional distance in a relationship. Finally, it is necessary to mention briefly the adverse effects of many medications on sexual desire, including antihypertensives and psychotropic medications—particularly SSRIs (Rosen et al., 1999).
Low sexual desire has been seen with increasing frequency in clinical practice. In fact, attenuated desire is now the most common complaint among patients seeking therapy (LoPiccolo & Friedman, 1988). However, treatment for low sexual desire can be a complex issue, as people with low sexual desire often have even lower levels of desire for ther apeutic intervention. Perhaps because of this, quality treatment outcome measures for low drive are relatively scarce (see O'Donohue et al., 1999). However, some studies have demonstrated good treatment results using a complex, cognitive-behavioral treatment program (LoPiccolo & Friedman, 1988) with a focus on low desire symptomatology (Schover & LoPiccolo, 1982). This focus on specific symptoms is seen as imperative to the success of treatment of low desire, as standard sex therapy often fails to raise desire (Kaplan, 1979).
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