Male Hypoactive Sexual Desire Disorder DSM-5 625.89 (F52.0)

Male Hypoactive Sexual Desire Disorder DSM-5 625.89 (F52.0)

DSM-5 Category:Sexual Dysfunctions

Introduction

The disease Male Hypoactive Sexual Desire Disorder (MHSDD) refers to the monosymptomatic criterion that:

  • the person has low desire for sex and and absent sexual thoughts or fantasies 
  • the disease causes marked distress or interpersonal difficulty
  • the disease is not a result of medical illness, another psychological disorder, or the effects of a drug.
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) introduced this specific disorder (APA, 2013). Prior to this edition, the DSM-III and DSM-IV-TR described HSDD more broadly to encompass both males and females. Over the years, many researchers investigated various aspects of how HSDD affects women, but, in comparison, there is a paucity of research that examines the ways that HSDD affects men. In 2010, Brotto discussed the prevalence of HSDD among women. Data suggests 34% of women between the ages of 18 and 74 experienced decreased sexual interest often or most of the time. When pursued by their partner or potential partner, women explained that they did experience arousal and interest in sexual activity. In consideration of this, women might not experience much sexual desire until appropriate stimulation occurs, thereby evoking both arousal and interest in sexual activity. In contrast, Vansintejan, Janssen, Van De Vijver, Vandevoorde, and Devroey (2013) reported an estimated 15% of the general male population experienced HSDD. For many years, experts believed sexual response was a three-stage cyclical process where: 1) the person was experiencing a desire to be sexual, 2) the individual searched for sexual stimulation and 3) the individual achieved orgasm (Benuto, 2014). However, the prevalence of HSDD among women has led an increasing number of researchers to question whether our present understanding of HSDD is accurate (Benuto, 2014).

Symptoms of Male Hypoactive Sexual Desire Disorder

The DSM-5 requirements for MHSDD are:

  • the patient must experience the disorder from 75% to 100% of the time for six months or longer.
  • Low sexual desire
  • On most occasions the patient reports marked delay, infrequency, or absence of orgasm during sexual activity for at least six months
  • Tendency to ejaculate within one minute of sexual activity
  • Causes clinically significant distress or interpersonal problems

Causes of Male Hypoactive Sexual Desire Disorder

The DSM-5 includes many risk factors and causes related to MHSDD. Looking at HSDD through a holistic lens, the DSM-5 assesses the patient's mental health and physical health. Regarding mental illness, symptoms of depression bring about a loss of interest in sexual activities. Anxiety, too, can impact a patient's sexual function. Beyond the psychological factors, numerous physical factors might influence sexual desire. Andropause has significant effects on sexual function. Benuto (2009) explains that hormonal levels of estrogen and testosterone gradually decrease with aging. Both hormones perform key functions in sexual desire. Medical procedures affecting sexual desire include prostate removal, pelvic radiation (oncological interventions might leave permanent sexual impairment damage), and procedures affecting the spinal cord can result in problems with sexual desire.

In 2012, Kring, Johnson, Davison, and Neale, discussed possible causes for MHSDD. The etiology, or causes, of MHSDD fall into biological factors or psychosocial factors. The biological factors are:

  • Diseases of the vascular system
  • Diseases of the nervous system
  • Low levels of testosterone or estrogen
  • Heavy alcohol consumption before sex
  • Depression
  • History of chronic alcoholism
  • Heavy cigarette smoking
  • Medications—antihypertensives and SSRIs

The psychosocial factors are:

  • Rape
  • Early childhood sexual abuse
  • Relationship problems—(anger, hostility, poor communication, underlying anxiety about relationship security)
  • Psychological disorders—(Major depression, anxiety, or panic disorder)
  • Low physiological arousal
  • Stress and exhaustion

Baldwin, Palzzo, and Masdrakis (2013) discuss a two-way relationship between reports of difficulties and dissatisfaction and the presence of depressive symptoms. The authors add that depressive symptoms frequently coexist with anxiety symptoms, which surround reports of sexual difficulties and often obsessive-compulsive symptoms. These symptoms are also related to a loss of sexual pleasure and sexual dissatisfaction. Most antidepressant drugs can unleash untoward effects on a man's sexual satisfaction and function. Considering the relative risks associated with sexual dysfunction coupled with antidepressant treatment, the adverse effects resulting from depression could be overlooked.

The DSM-5 states that a loss of sexual interest and energy— mood, self-esteem, and the individual's capacity for pleasure — could be connected to depression, which is why the manual also recommends a screening for depression. However, accurately identifying the onset of "treatment-emergent" sexual dysfunction (including both the worsening of preexisting problems and the development of new sexual difficulties in patients previously untroubled) during antidepressant treatments can be challenging (Baldwin, Palzzo, and Masdrakis (2013).

Treatment for Male Hypoactive Sexual Desire Disorder

According to the DSM-5, treatment options for patients experiencing low sexual desire might find improvements from psychotherapy and hormonal replacement therapy. Hormonal treatments include oral compounds that are in pill form, subcutaneous creams, suppositories or patches that are absorbed through the skin.

Testosterone is a hormone that creates sexual desire in both men and women.

Frequently, physicians test the patient's testosterone levels. The DSM-5 states that treating HSDD involves removing the principal issue. Examples include, but are not limited to, relationship counseling, changing prescription medication, administering IM testosterone, and, in some circumstances, androgen deficiency ("How to get rid," 2013).

In 2009, Benuto explained that mindfulness techniques can be useful when treating low levels of sexual desire. The author describes mindfulness as a present-moment awareness that branches off from Buddhist meditation. Jon Kabat Zinnn brought mindfulness to Western healthcare and used it to address many psychological disorders, including depression, anxiety, borderline personality disorder, and chronic physical pain. Mindfulness teaches the patient to focus on what is happening now. Research indicates that practicing mindfulness may improve sexual desire levels.

Baldwin, Palazzo and Masdrakis assert that other approaches for managing patients suffering from MHSDD include antidepressant drugs; however, the extensive literature involving randomized placebo-controlled investigations is limited (Baldwin, Palzzo, and Masdrakis, 2013). Only a few adjuvant compounds advocated to alleviate sexual dysfunction have proved to be beneficial, including, bupropion, olanzapine, testosterone gel and the phosphodiesterase-5 inhibitors sildenafil and tadalafil.

The DSM-5 states that side effects of some antidepressants could be related to the patient's dosage. A reduction in the prescribed daily dosage is frequently the initial step to management. Unfortunately, a reduction in dosage might evoke a relapse of symptoms related to depression. This course should be considered only for those men who reached a full symptomatic remission and who have successfully completed the continuation treatment. Baldwin, Palzzo, and Masdrakis (2013) explain that interruptions of an antidepressant drug treatment - "a drug holiday" - can have potential use for some antidepressants. Although only a proportion of men described improvements in sexual function (only with some antidepressants), depressive symptoms tend to worsen. Also, symptoms resulting from cessation bring general concerns, thereby making this approach potentially hazardous and uncommon. Medications and physical treatments include the squeeze technique for early ejaculation and PDE-5 inhibitors for erectile dysfunction (e.g., phosphodiesterase type 5 inhibitors [sildenafil (Viagra), tadatil (Cialis) and vardenafil (Levitra)]). 

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Baldwin, D. S., Palazzo, M. C., & Masdrakis, V. G. (2013). Reduced treatment-emergent sexual dysfunction as a possible target in the development of new antidepressants [PowerPoint slides]. Retrieved from http://www.hindawi.com/journals/drt/2013/256841/

Benuto, L. (2014). Sexual desire disorders: Hypoactive sexual desire disorder. Retrieved from http://sevencounties.org/poc/view_doc.php?type=doc&id=29725&cn=10

Benuto, L. (2009). Sexual desire disorders: Hypoactive sexual desire disorder. Retrieved from http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=29725&cn=10

Brotto, L. A. (2010). The DSM diagnostic criteria for hypoactive sexual desire disorder in men. Journal of Sexual Medicine, 7: 2015-2013. Doi: 10.1111/j.1745-6109.2010.01860.x

How to get rid of hypoactive sexual desire disorder (HSDD). (2013). Hypoactive sexual desire disorder overview, cause, symptoms, treatment, medication. Retrieved from http://www.depression-guide.com/hypoactive-sexual-desire-disorder.htm

IsHak, W. W. & Tobia, G. (2013). DSM-5 changes in diagnostic criteria of sexual dysfunctions. Reproductive System & Sexual Disorders, 2 (122). doi: 10.4172/2161-038X.1000122. Retrieved from http://www.ipfw.edu/dotAsset/0d2c4e22-25e0-43db-a680-ab19a693e399.pdfhttp://omicsonline.org/dsm-5-changes-in-diagnostic-criteria-of-sexual-dysfunctions-2161-038X.1000122.php?aid=18508

Kring, A. M., Johnson, S. L., Davison, G. C., & Neale, J. M (2012). Sexual Disorders. In Abnormal psychology, Twelfth edition (Chapter 12). Retrieved from

Vansintejan, J., Janssen, J., Van De Vijver, E., Vandevoorde, J., Devroey, E. (2013). The gay men sex studies: Prevalence of sexual dysfunctions in being hiv+ gay men. In Hiv Aids (Auckl). doi: 10.2147/HIV.S43962. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3643290/

Safer, D. A. (2014). Psychosexual dysfunction. Retrieved from http://psych.med.nyu.edu/patient-care/conditions-we-treat/hypoactive-sexual-desire


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