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Evaluation

• Definition: DSM V combined Hypoactive Sexual Desire Disorder (HSDD) and Female Sexual Arousal Disorder (FSAD) into FSID
• Prevalence: ~40% women will be affected at some point during lifetime
• Criteria: defined as decreased motivation, decreased desire, loss of interest, leading to personal distress, present for 6+ months
• Exacerbating medical conditions: HTN, DM, thyroid dysfunction, hyperprolactinemia, CKD, SCI, MS, Parkinson, dementia, postmenopause, PCOS, breast cancer + treatments, depression
• Associated medications: anticonvulsants, cardiac meds, hormonal therapy, NSAIDs, opioids, psychotropics, illicit drugs, antihistamines, KTZ, chemotherapy
• Workup: physical exam and labs are not necessary but may be helpful to rule out specific causes
• Questionnaire: assess with the decreased sexual desire screen (DSDS)

Management

• Psychotherapy: consider behavioral, CBT, and mindfulness
• Flibanserin (Addyi): FDA-approved for premenopausal women with low sexual desire, 100mg PO QHS, side effects include dizzinesss, somnolence, nausea, fatigue, contraindicated with alcohol
• Bremelanotide (Vyleesi): melanocortin receptor agonist, 1.75mg subQ 45min prior to sexual activity, improves desire and decreases distress, 40% develop nausea, contraindicated if uncontrolled HTN or CVD, do not use more than daily, can cause hyperpigmentation if used > 8x/mo
• Ospemifene: SERM indicated for vulvovaginal atrophy and dyspareunia in postmenopausal women, 60mg daily
• Testosterone can consider after discussing androgenic side effects
• Antidepressants: consider bupropion (300-400mg daily) or buspirone (20-60mg daily)
• Devices: consider clitoral suction to promote engorgement (similar to vacuum erection device)