Hypoactive Sexual Desire Disorder: International Society for the Study of Women's Sexual Health (ISSWSH) Expert Consensus Panel Review

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• 作者：Irwin Goldstein ; MD^a ; ^{dr.irwingoldstein@gmail.com} ; Noel N. Kim ; PhD^b ; Anita H. Clayton ; MD^c ; Leonard R. DeRogatis ; PhD^d ; Annamaria Giraldi ; MD ; PhD^e ; Sharon J. Parish ; MD^f ; James Pfaus ; PhD^g ; James A. Simon ; MD^h ; Sheryl A. Kingsberg ; PhDⁱ ; Cindy Meston ; PhD^j ; Stephen M. Stahl ; MD^k ; Kim Wallen ; PhD^l ; Roisin Worsley ; MBBS^m
• 关键词：ACC ; anterior cingulate cortex ; AE ; adverse event ; ArcN ; arcuate nucleus of the hypothalamus ; CB1s ; cannabinoid type 1 receptor ; CBT ; cognitive behavior therapy ; CPu ; caudate-putamen ; δ ; delta opioid receptors ; DA ; dopamine ; DSM ; Diagnostic and Statistical Manual of Mental Disorders ; FDA ; Food and Drug Administration ; GnRH ; gonadotropin-releasing hormone ; HSDD ; hypoactive sexual desire disorder ; ICD-10 ; International Statistical Classification of Diseases and Related Health Problems ; 10th Revisi
• 刊名：Mayo Clinic Proceedings
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：92
• 期：1
• 页码：114-128
• 全文大小：3404 K
• 卷排序：92

文摘

The objective of the International Society for the Study of Women's Sexual Health expert consensus panel was to develop a concise, clinically relevant, evidence-based review of the epidemiology, physiology, pathogenesis, diagnosis, and treatment of hypoactive sexual desire disorder (HSDD), a sexual dysfunction affecting approximately 10% of adult women. Etiologic factors include conditions or drugs that decrease brain dopamine, melanocortin, oxytocin, and norepinephrine levels and augment brain serotonin, endocannabinoid, prolactin, and opioid levels. Symptoms include lack or loss of motivation to participate in sexual activity due to absent or decreased spontaneous desire, sexual desire in response to erotic cues or stimulation, or ability to maintain desire or interest through sexual activity for at least 6 months, with accompanying distress. Treatment follows a biopsychosocial model and is guided by history and assessment of symptoms. Sex therapy has been the standard treatment, although there is a paucity of studies assessing efficacy, except for mindfulness-based cognitive behavior therapy. Bupropion and buspirone may be considered off-label treatments for HSDD, despite limited safety and efficacy data. Menopausal women with HSDD may benefit from off-label testosterone treatment, as evidenced by multiple clinical trials reporting some efficacy and short-term safety. Currently, flibanserin is the only Food and Drug Administration–approved medication to treat premenopausal women with generalized acquired HSDD. Based on existing data, we hypothesize that all these therapies alter central inhibitory and excitatory pathways. In conclusion, HSDD significantly affects quality of life in women and can effectively be managed by health care providers with appropriate assessments and individualized treatments.