Hypoactive Sexual Desire Disorder (low sex drive)

Hypoactive sexual desire disorder, or HSDD, is a lasting reduction in sexual desire, or its absence, that causes the person distress. Low desire on its own is common and is not a disorder. What defines HSDD is that the change has continued and that it troubles the individual who has it.

What HSDD is, and what it is not

The distinguishing feature is distress, not a level of desire. International consensus recommendations followed in Canadian practice describe HSDD as a persistent reduction in or absence of desire that causes the person personal distress. Many people notice desire changing over the years and are not troubled by it, and for them there is nothing to diagnose or treat.

It is also not a character trait, a relationship failing, or something that only happens at one stage of life. It is a recognised clinical condition that can begin at any point in adult life. And it is not diagnosed when the change is fully explained by something else, such as an ongoing relationship conflict, a medication, or another medical condition, because in that case the other cause is what gets addressed.

Signs and symptoms

• An ongoing reduction in, or absence of, interest in sexual activity
• Little or no spontaneous sexual thought or fantasy
• Reduced response to cues that previously prompted interest
• Difficulty maintaining interest once sexual activity begins
• Distress, frustration or worry about the change
• A change from what was previously usual for that person, lasting six months or more
• A change that is not explained on its own by a relationship conflict, a medication or another medical condition

How this shows up varies between people. For some the change applies to every situation, and for others only to some, which is one of the things a clinician asks about.

What raises the risk

Some things cannot be changed:

• Surgical menopause, which international consensus work identifies as more common among people diagnosed with HSDD
• Natural menopause and the hormonal changes that come with it
• Long-term medical conditions, including those affecting hormones, circulation or the nervous system
• A history of depression or anxiety

Others can often be worked on, usually with support from a health care team:

• Certain medications, including some antidepressants, which can be reviewed with the prescriber
• Sleep loss, ongoing stress and fatigue
• Relationship distress, communication difficulties, and pain during sex that has not been treated

How HSDD is diagnosed in Canada

There is no blood test for HSDD. International consensus recommendations followed in Canadian practice describe it as a clinical diagnosis based on a focused sexual and medical history: when the change began, how long it has lasted, whether it applies to all situations or only some, and how distressing it is. A physical examination is done only when the history points to a physical cause. Clinicians also go through medications, mood, sleep, pain during sex and relationship context before reaching a conclusion, because any of those can account for the change on its own.

Treatment and day-to-day management

Clinical research for Hypoactive Sexual Desire Disorder (low sex drive) is enrolling. See the current studies ↓

Care is usually built around what the history points to, and often addresses more than one contributing factor at a time. Depending on your situation and what matters to you, a health care team may discuss:

• Psychological and behavioural approaches, including sex therapy, cognitive behavioural therapy and mindfulness-based therapy
• Reviewing and adjusting medications that can contribute to reduced desire, done with the prescriber
• Treating contributing conditions such as pain during sex, vaginal dryness, depression, anxiety or sleep disorders
• Centrally acting prescription medicines described in international consensus recommendations, including flibanserin and bremelanotide, whose availability differs from country to country
• Hormonal approaches described in international consensus recommendations, including testosterone in postmenopausal women, prescribed and monitored by a clinician

Which of the prescription options are available for sale in Canada is worth confirming with a clinician or pharmacist, because that has not been established on this page. What suits one person will not suit another, and whether any of this applies to you is a decision for you and your own clinician. This page is not a recommendation about any of it.

When to talk to a doctor

• Consider speaking with a clinician if a lasting change in sexual desire is causing you distress, or if it has continued for six months or more.
• Book an appointment if the change began after starting a new medication, after surgery, or alongside a new medical condition, since those are reviewable causes.
• Seek assessment promptly for pain during sex, unexplained bleeding, or desire changes accompanied by low mood, hopelessness or thoughts of self-harm. In Canada you can call or text 988, the Suicide Crisis Helpline, at any time.

Why clinical research matters for HSDD

There is still no biological marker for HSDD, no agreement on the best way to measure distress, and limited evidence on how the condition presents across different ages, cultures and gender identities. Canada has no population-level data on how many people meet the criteria or receive care, which makes planning services difficult. The Canadian figure on this page measures low desire rather than the diagnosis, covers only adults aged 40 to 59, and dates from 2018; one recent systematic review noted that HSDD was not reported as a distinct measure in any of its included studies, which is part of why international estimates range so widely. Research now under way includes trials of centrally acting compounds, studies of psychological and mindfulness-based therapies delivered in person and online, work on testosterone in postmenopausal women, and studies of desire in people affected by cancer treatment and by surgical menopause.

Clinical studies are how those questions get answered. Taking part is voluntary, you give informed consent before anything begins, and you can stop at any time without affecting the care you get from your own doctor. Joining a study does not mean giving up your current treatment, and no one can tell in advance whether a study will help you personally.

Learn more from Canadian sources

• Sex and U, Society of Obstetricians and Gynaecologists of Canada
• Menopause and U, Society of Obstetricians and Gynaecologists of Canada
• Action Canada for Sexual Health and Rights: Access Line and service provider directory
• Menopause Foundation of Canada