��15 The report of the International Consensus Development Conference on Female Sexual Dysfunction classified sexual dysfunction in women into sexual desire disorders. These disorders are subclassified as hypoactive sexual desire disorder (HSDD), sexual aversion, female sexual arousal disorder, female orgasmic disorder, and sexual pain disorder, encompassing dyspareunia and vaginismus.15,16 MEK162 mw Most studies do not segregate the elderly population from all patients with sexual dysfunction. HSDD, with a prevalence of 22%, is the persistent or recurrent absence of sexual fantasies or thoughts and desire for or receptivity to sexual activity that causes personal distress.15 HSDD may be a primary, lifelong condition in which the patient has never felt much sexual desire or interest, or it may occur secondarily when the patient formerly had sexual desire, but no longer has interest (aka, acquired HSDD).
17 HSDD can also be generalized (general lack of sexual desire) or situational (still has sexual desire, but lacks sexual desire for her current partner17). In a study by Hartmann and colleagues,18 79% of patients suffered from secondary and generalized HSDD. When a woman describing lack of libido has really never had much interest in sexual activity, treatment is less likely to be successful. The cause is not considered to be hormonal because libido was lacking in these women even when estrogen and testosterone were at premenopausal levels.5 Little is known about why some women have a much lower sex drive than others. Some postulated theories are early abuse, relationship difficulties, or psychologic factors such as depression.
5 Lack of interest can be affected by medications, family situations, work-related issues, and psychologic factors.1 Sexual aversion disorder is the persistent or recurrent phobic aversion to and avoidance of sexual contact with a sexual partner that causes personal distress. Sexual arousal disorder is the persistent or recurrent inability to attain or maintain sufficient sexual excitement that causes personal distress, which may be expressed as a lack of subjective excitement, lack of genital lubrication, or some other somatic response. Orgasmic disorder is the persistent or recurrent difficulty, delay in, or absence of attaining orgasm following sufficient sexual stimulation and arousal that also causes personal distress.
Psychologic issues, antidepressants, alcohol use, and drugs have all been responsible in causing anorgasmia.15 Sexual pain disorders, such as dyspareunia, are described as recurrent or persistent genital pain associated with sexual intercourse. Brefeldin_A The most common causes are infection, surgery, medications, endometriosis, and interstitial cystitis. Vaginismus is the recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with vaginal penetration that causes personal distress.