Fast Five Quiz: Female Sexual Interest/Arousal Disorder/Hypoactive Sexual Desire Disorder

Christine Isaacs, MD


April 03, 2019

While there are several forms of female sexual dysfunction (FSD), the DSM-V defines FSIAD as reduced or absent sexual desire that occurs at least 75% of the time over a 6-month period and causes patient distress.

Because many women with FSIAD/HSDD are reluctant to discuss symptoms and concerns, routine questioning about sexual health and activity by primary care physicians (PCPs) and specialists facilitates the discussion and encourages patients to open up about any sexual concerns or dysfunction-related issues they may have. This in turn guides clinicians in the appropriate workup, management, and follow-up.

The Female Sexual Dysfunction Index, the Female Sexual Distress Scale, and the Brief Sexual Symptoms Checklist for Women are excellent tools to help clinicians obtain a detailed patient history. In addition, the Permission, Limited Information, Specific Suggestion, Intensive Therapy (PLISSIT) model is an effective method to help PCPs initiate a conversation with patients about their sexual health. In this model, the clinician gives the patient "permission" to talk about any sexual health issues. After the patient has opened up about concerns, the PCP provides the patient with limited information and possible causes of the symptoms, along with specific suggestions. After the discussion, the PCP refers the patient to a specialist for intensive therapy (sex therapy or a follow-up appointment to specifically address the sexual problem). The PLISSIT model further encourages continued patient-clinician communication and follow-up.

Physical, psychological, and cultural factors can affect female sexuality and contribute to FSIAD/HSDD. Because these factors often overlap, determining the etiology of a patient's FSIAD/HSDD can be challenging. Hormone and neurotransmitter imbalances, relationship stress, psychosocial issues, and psychiatric history are key areas of focus when diagnosing and treating affected women.

For more on the workup for FSIAD/HSDD, read here.


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