Lifelong: The disturbance has been present since the individual became sexually active.
Acquired: The disturbance began after a period of relatively normal sexual function.
Specify whether:
Generaiized: Not limited to certain types of stimulation, situations, or partners.
Situational: Only occurs with certain types of stimulation, situations, or partners.
Specify current severity:
Mild: Evidence of mild distress over the symptoms in Criterion A.
Moderate: Evidence of moderate distress over the symptoms in Criterion A.
Severe: Evidence of severe or extreme distress over the symptoms in Criterion A.
When an assessment for male hypoactive sexual desire disorder is being made, inter— personal context must be taken into account. A “desire discrepancy,” in which a man has lower desire for sexual activity than his partner, is not sufficient to diagnose male hypo- active sexual desire disorder. Both low/absent desire for sex and deficient/absent sexual thoughts or fantasies are required for a diagnosis of the disorder. There may be variation across men in how sexual desire is expressed.
The lack of desire for sex and deficient/absent erotic thoughts or fantasies must be per- sistent or recurrent and must occur for a minimum duration of approximately 6 months.
The inclusion of this duration criterion is meant to safeguard against making a diagnosis in cases in which a man’s low sexual desire may represent an adaptive response to adverse life conditions (e.g., concern about a partner’s pregnancy when the man is considering ter- minating the relationship). The introduction of "approximately" in Criterion B allows for clinician judgment in cases in which symptom duration does not meet the recommended 6-month threshold.
Male hypoactive sexual desire disorder is sometimes associated with erectile and/ or ejac- ulatory concerns. For example, persistent difficulties obtaining an erection may lead a man to lose interest in sexual activity. Men with hypoactive sexual desire disorder often report that they no longer initiate sexual activity and that they are minimally receptive to a part- ner’s attempt to initiate. Sexual activities (e.g., masturbation or partnered sexual activity) may sometimes occur even in the presence of low sexual desire. Relationship-specific pref- erences regarding patterns of sexual initiation must be taken into account when making a diagnosis of male hypoactive sexual desire disorder. Although men are more likely to ini- tiate sexual activity, and thus low desire may be characterized by a pattern of non—initiation, many men may prefer to have their partner initiate sexual activity. In such situations, the man’s lack of receptivity to a partner’s initiation should be considered when evaluating low desire.
In addition to the subtypes ”lifelong /acquired" and "generalized / situational,” the fol- lowing five factors must be considered during assessment and diagnosis of male hypo- active sexual desire disorder given that they may be relevant to etiology and / or treatment: 1) partner factors (e.g., partner’s sexual problems, partner’s health status); 2) relationship factors (e.g., poor communication, discrepancies in desire for sexual activity); 3) individ- ual vulnerability factors (e.g., poor body image, history of sexual or emotional abuse), psy- chiatric comorbidity (e.g., depression, anxiety), or stressors (e.g., job loss, bereavement); 4) cultural/ religious factors (e.g., inhibitions related to prohibitions against sexual activity; attitudes toward sexuality); and 5) medical factors relevant to prognosis, course, or treat- ment. Each of these factors may contribute differently to the presenting symptoms of dif- ferent men with this disorder.
The prevalence of male hypoactive sexual desire disorder varies depending on country of origin and method of assessment. Approximately 6% of younger men (ages 18—24 years) and 41% of older men (ages 66—74 years) have problems with sexual desire. However, a persistent lack of interest in sex, lasting 6 months or more, affects only a small proportion of men ages 16—44 (1.8%).