Reduced sexual desire in womenBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b2371 (Published 10 August 2009) Cite this as: BMJ 2009;339:b2371
- P S Arunakumari, locum consultant1,
- S Walker, general practitioner and associate specialist 2
- 1Obstetrics and Gynaecology, Royal United Hospital Bath NHS Trust, Bath BA1 3NG
- 2Psychosexual Medicine, Box Surgery, Wiltshire SN13 8NA
- Correspondence to: P S Arunakumari
- Accepted 5 September 2008
A 44 year old woman comes to see you because she is “never in the mood.” She has been married for eight years, works as a sales assistant, and is healthy.
What issues you should cover
Define reduced sexual desire—The Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), defines hypoactive sexual desire as a deficiency or absence of sexual desire or fantasy causing personal distress, interpersonal difficulty, or both. Explore exactly what she means by never being in the mood. Does she initiate sex? What kind of sexual contact is she having (or not)?
Causes—These can be psychological (most cases) or physical, although they often overlap. Relationship problems (unexpressed negative feelings about the partner, extramarital affairs), motivational problems (fear of loss of femininity, loss of reproductive potential), cognitive problems (low self image and self esteem), family problems (“empty nest” syndrome), and life stresses (retirement, financial worries) are common associations. Physical causes can be systemic (anaemia, …