What Women Want? The State of the Art regarding the Treatment of Young Women with Hypoactive Sexual Desire Disorder.
This review article summarizes discussions from a round table held at the European Society for Sexual Medicine (ESSM) meeting in Rotterdam (February 2023), where leading experts addressed the diagnosis and treatment of hypoactive sexual desire disorder (HSDD) in premenopausal women. The authors note that HSDD is the most prevalent female sexual disorder, reported by approximately 28% of the estimated 40% of premenopausal women experiencing sexual dysfunction. The review covers the multifactorial nature of HSDD, encompassing biological, psychological, and sociocultural dimensions—including depression, sexual abuse history, gender-based "pleasure gaps," and structural inequalities. Regarding pharmacotherapy, the authors note that flibanserin and bremelanotide are the only FDA-approved treatments in the USA, while no medications are approved in Europe; compounds such as Lybrido, Lybridos, and Lorexys remain under development. The review reports that evidence supports combining pharmacological and psychosocial approaches, though clinician opinion remains divided. It also highlights that some women express a clear desire for access to drug-based options. A key limitation is that this article is expert opinion and narrative review rather than a systematic review or primary study, limiting the strength of its evidence base.
Why this grade: This is a narrative expert-consensus review article based on a round table discussion, not a primary study or systematic review with pooled data, so it does not independently generate human evidence.
Background Hypoactive sexual desire disorder (HSDD) in premenopausal women involves biological, psychological, and social aspects. In the European Society for Sexual Medicine meeting in Rotterdam in February 2023, several leading experts in the field discussed the multifaceted nature of this disorder and the state of the art regarding treatment at a round table. This review reflects the information discussed at this event and further discusses current controversies. Summary HSDD is the most prevalent female-estimated sexual disorder reported by 28% of the 40% premenopausal women with sexual dysfunction. Flibanserin and bremelanotide are the only approved medications to treat HSDD in the USA, and none are approved in Europe. Lybrido, Lybridos, and Lorexys are under development. There are several psychological factors with impact in sexual desire, including depression and sexual abuse. Feminine sexual scripts, the pleasure gap, and structural inequalities also affect sexual desire. Evidence strongly supports the value of combining medical and psychological approaches in the treatment of HSDD, but there is ongoing controversy regarding the pharmacological treatment of young women with HSDD. However, some women seem open and would like to have access to drug treatment. Key messages The treatment of HSDD in young women requires a mixed treatment approach that addresses the disorder's complexity. Despite clinicians seeming to be divided between using pharmacological and/or psychosocial approaches, some women might respond better to one type of intervention over the others. This calls for the development of tools that assess the best approach for each person, including their will and informed choice.
Educational summary of published research — not medical advice. License: cc by-nc. Full text is shown only where licensing permits.