Challenges in the identification and management of HSDD.

This case illustrates some of the challenges involved in establishing a diagnosis of female sexual dysfunction and, specifically, hypoactive sexual desire disorder (HSDD). Problems with sexual desire and arousal may indicate a primary diagnosis of HSDD or may occur secondary to factors such as poorly controlled depressive symptoms, the manifestations of menopause, or the side effects of antidepressant medications. Moreover, declining estrogen levels beginning during perimenopause may decrease vaginal lubrication and cause atrophy of vaginal tissue, which can result in discomfort during intercourse and can also reduce desire. Because of the complex interplay among many factors, it is not always possible to clearly identify the "primary" disorder in a patient such as the one in this case. An important consideration is that personal distress must be present to establish a diagnosis of HSDD.