Hypoactive sexual desire is probably the most prevalent of all the sexual dysfunctions. Harold Lief has reported that 40 percent of patients applying to the Marriage Counsel of Philadelphia for help with sexual problems were suffering primarily from what he terms inhibited sexual desire, or ISD. This is consistent with our own experience. Since we have begun to take cognizance of disturbances in libido we have also found that desire problems are extremely common in our population.

Definition And Description

The nomenclature committee of the American Psychiatric Association has organized its classification of the sexual dysfunctions according to the triphasic concept of the sexual response and has recognized ISD as a clinical entity. In DSM III (the third edition of the Diagnostic and Statistical Manual of the APA), Desire Phase Inhibition is defined as follows:

A. Persistent and pervasive inhibition of sexual desire. The basis for the judgment of inhibition is made by the clinician taking into account age, sex, occupation, the individual's subjective statement as to intensity and frequency of sexual desire, a knowledge of norms of sexual behavior, and the context of the individual's life. In actual practice, this diagnosis will rarely be used unless the lack of desire is a source of distress either to the individual or to his or her partner. Frequently this category will be used in conjunction with one or more of the other dysfunction categories.

B. The disturbance is not caused exclusively by organic factors and is not symptomatic of another clinical psychiatric syndrome.

For conceptual clarity, the term ISD is reserved here for those situations of abnormally low libido in which an etiologic diagnosis has been made, i.e., when it is established that sexual desire is inhibited by psychic factors. The term hypoactive sexual desire (HSD) is preferable when the etiology of low libido has not yet been determined. The term sexual avoidance employed by Masters and Johnson to describe persons who have a low frequency or absence of sexual activity can be confusing. Inhibition of desire is but one of several possible causes of asexual behavior and a patient may develop a pattern of avoidance of sexuality whether he feels sexual desire or not. It is true, however, that some patients who have ISD also develop phobic avoidance of sex, and this is of clinical importance. (see PSYCHOSEXUAL DYSFUNCTION WITH INHIBITED SEXUAL DESIRE PART II)