Subtypes of HSDD

Clinicians are directed to subtype the diagnosis of HSDD, that is, to say if the pattern has been (A) "lifelong" or "acquired" (i.e., always existed since puberty or followed a period of "normal" sexual desire), (B) "situational" or "generalized" (i.e., has existed only in some sexual circumstances or all) and (C) due to psychological or combined factors. Maurice (12; pp. 54-55) considers diagnostic subtyping to be clinically useful in helping to point towards the etiology and thus assessment and treatment—for example, acquired problems would require a more diligent search for the explanation of change than those which are lifelong. Likewise, if a man has a situational difficulty, for example, not sexually active with his partner but masturbating several times each week, there is little rationale for considering some biological explanation since his SRC is obviously intact.

Maurice has described four HSDD syndromes: (i) desire discrepancy, (ii) lifelong and generalized, (iii) acquired and generalized, and (iv) acquired and situational (12; pp. 161-165). On the basis of clinical impression, the most common desire difficulties in men are those that are (A) lifelong but also situational (very unusual in women) and (B) acquired and generalized— usually resulting from a medical, psychiatric, or other sexual, disorder (Fig. 4.1).

Although clinically useful, these syndromes have not been the subject of empirical research. Nevertheless, one can sometimes extract information from survey data that seem to apply to this scheme. For example, Kinsey et al. described a small group of men (147 from approximately 12,000 interviewed) who they referred to as "low rating" [defined as under 36 years old and whose

PRL = prolactin; T= testosterone; TSH = thyroid-stimulating hormone Figure 4.1 Assessment of low sexual desire disorder in men.

rates (of sexual behavior) averaged one event in 2 weeks or less] (13; p. 207). They also described another group of men about half as large in number as "sexually apathetic" in that "they never, at any times in their histories, have given evidence that they were capable of anything except low rates of activity" (p. 209). One could conclude from Kinsey's observations that not only did these men have a lifelong and generalized disinterest in sexual matters, but also they were quite unusual.

Lifelong and Situational

"The most striking feature that differentiates a situational desire disorder from one that is generalized is the continued presence of sexual desire in some form. The sexual feelings that do exist in the present occur typically when the person is alone and are manifest either in thought and/or action (through masturbation), rather than in sexual activity with the patient's usual partner ...the present level of sexual activity (with the partner) often represents a... change from the beginning of the relationship when the frequency was... greater." (12; p. 165) Detailed history-taking reveals that even at the start of the relationship, the woman often took the sexual initiative and even then, sexual experiences took place infrequently.

In this syndrome, the man's desire disorder represents a lifelong pattern but is also situational, because there are times when he can be quite sexual, typically when alone through masturbation, or at the beginning of a new relationship with a partner.

0 0

Post a comment