Sex drive and sexual desire.

Abstract

Loss of sexual desire is increasingly recognized as a consequence of many disease processes, and one that can have a significant negative impact on quality of life. This review explores the biological and psychological aspects of desire, as well as the aetiology and therapeutic options for loss of desire. Discoveries have been made in terms of the physiology of desire in men, in that it is affected by estradiol as well as testosterone. It has also been shown that desire is less gender specific in androphilic women than in androphilic men and gynaephilic men and women. Fatigue has been described as the most common self-reported cause of loss of desire, with communication as the most common method for addressing this. In men, a clear distinction has been shown between disorders of arousal and disorders of desire, suggesting that they should remain as separate conditions in the Diagnostic and Statistical Manual of Mental Disorders criteria. Loss of desire has been proven to be a significant consequence of diabetes, multiple sclerosis and polycystic ovary syndrome and can occur as a side-effect of statins and 5α-reductase inhibitors. Testosterone therapy may be an effective treatment for loss of desire in both men and women, and is safe in the treatment of men who have been treated for prostate cancer. It also has a significant impact on desire when used in the treatment of individuals with gender dysphoria. Nonhormonal treatments including flibanserin and new methods of therapy may also be effective. Loss of desire is underrecognized as a symptom of disease or as a complaint in its own right. As further developments in treatment options, both therapies based and pharmacological, are made, it is increasingly important that clinicians enquire about sexual dysfunction, including loss of desire, at every consultation.