THE SCIENCE BEHIND HSDD

The brain is the central regulator of sexual desire1

Hypoactive sexual desire disorder (HSDD) is believed to be caused by an imbalance of neurotransmitters. There may be too few excitatory signals (such as dopamine or melanocortins) or too many inhibitory signals (such as serotonin) or a combination of both, which impacts sexual desire.2
Normal sexual function: Excitatory signals - DA, NE, Oxytocin, MCs. Inhibitory signals - 5-HT, Opioids, ECBs.
Normal sexual function: Excitatory signals - DA, NE, Oxytocin, MCs. Inhibitory signals - 5-HT, Opioids, ECBs.

Adapted from Kingsberg SA et al. CNS Drugs. 2015;1(1):1-19.

Her HSDD Story: Kelly, 25

Kelly’s frustrated. She’s tried everything, but can’t desire her fiancé the way she used to.

The brain controls desire differently in women with HSDD3

When women with HSDD were shown an erotic video, positron emission tomography (PET) scans showed differing levels of blood flow to areas of the brain important in sexual response than in women without HSDD.4

  • In women without HSDD, the left brain, which is involved in daily work activities, was deactivated when shown the erotic stimuli. The right brain, which is involved in sexual arousal, was activated when shown erotic stimuli4,5
  • Women with HSDD showed minimal deactivation and activation in these brain areas, both critical for sexual function4,6

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Adapted from Goldstein I et al. Mayo Clin Proc. 2017;92(1):114-128.

http://www.sciencedirect.com/journal/mayo-clinic-proceedings.

©2017 with permission from Elsevier.

HSDD is not caused by hormonal differences4,7

  • Like women without HSDD, women with HSDD have normal hormonal and menstrual cycles with elevations in estrogen and testosterone at ovulation
  • Unlike women without HSDD, those with HSDD do not experience an increase in sexual desire at the time of ovulation, when sexual desire is supposed to peak
Guide the conversation about her low sexual desire and associated distress

References

References: 1. Pfaus JG. Pathways of sexual desire. J Sex Med. 2009;6(6):1506-1533. 2. Kingsberg SA, Clayton AH, Pfaus JG. The female sexual response: current models, neurobiological underpinnings and agents currently approved or under investigation for the treatment of hypoactive sexual desire disorder. CNS Drugs. 2015;29(11):915-933. 3. Bloemers J, Scholte SH, van Rooij K, et al. Reduced gray matter volume and increased white matter fractional anisotropy in women with hypoactive sexual desire disorder. J Sex Med. 2014;11(3):753-767. 4. Goldstein I, Kim NN, Clayton AH, et al. Hypoactive sexual desire disorder. International Society for the Study of Women’s Sexual Health (ISSWSH) expert consensus panel review. Mayo Clin Proc. 2017;92(1):114-128 5. Holstege G. How the emotional motor system controls the pelvic organs. Sex Med Rev. 2016;4(4):303-328. 6. Clayton AH, Hamilton DV. Female sexual dysfunction. Obstet Gynecol Clin North Am. 2009;36(4):861-876. 7. Pfaus JG, Jones SL, Flanagan-Cato LM, Blaustein JD. Female sexual behavior. In: Plant T, Zeleznik A, eds. Knobil and Neill’s Physiology of Reproduction. 4th ed. New York, NY: Elsevier; 2015:2287-2370.