Pharmacy hours interviewed Rachel Rubin, MD, assistant clinical professor of urology at Georgetown University, a urological surgeon specializing in the treatment of sexual dysfunction in both men and women, and one of the few physicians trained in female sexual medicine and male, on hypoactive sexual desire disorder (HSDD) and the current treatments available for this medical condition.
Alana Hippensteele: What is hypo-sexual desire disorder and how many women and men does it affect?
Rachel Rubin: Thank you very much for having me. It is truly an honor to be here. Just a clarification – it’s hypoactive sexual desire disorder. It’s just fancy medical terminology for low libido and when you’re bothered by low libido.
So low libido really isn’t a medical condition if you don’t mind, but if you say, “Oh my God, I used to really want intimacy and sexual activity, and now I don’t want it anymore, but I want to want it,” or if you’re thinking, “God, my partner used to initiate and I used to respond and I really liked being with my partner, and now I don’t want that at all, and it bothers me”—it’s a medical condition.
If it doesn’t bother you, there’s no reason to see a doctor, but it bothers a lot of people. So interestingly when you look at the data, particularly among women, about 40% of women have what we would call low libido, but only about 10% are bothered by it, which is only about 10% with this HSDD diagnosis.
Alana Hippensteele: It’s really interesting. Is HSDD always associated with psychological and/or emotional components, or can it be a purely physical disorder separate from psychological or emotional complications?
Rachel Rubin: That’s such a good question, and I don’t know about you, but I can’t get my brain out of my biology; I can’t take it off. So I follow my psychosocial education, I follow my psychology, it’s part of biology.
I think the idea is that we are all biopsychosocial beings and that biology plays a really important role in sexual health and especially in HSDD. There are a lot of patients I have who come to me and say, “Hey, Dr. Rubin, I love my partner. We have so much fun together and we are great parents together. We appreciate each other. There’s nothing wrong with our relationship, I’m not depressed, I’m not anxious, I have no medical issues, I don’t want sex anymore. But I really wanted it, and I really miss wanting it, and can we do something about it. In these situations, we have biological solutions that can potentially help in these situations.
Alana Hippensteele: For those with psychological and/or emotional comorbidity with HSDD, what conditions are commonly associated with it?
Rachel Rubin: So anything that affects your brain and mental health can affect your sexual function – sexual health is just health. So why I love my job so much is because I get to work with people and really break down what’s going on in their physical and mental health and how it can affect their plumbing and how it can affect their health. play as a partner.
So, my knowledge of biology is really helpful as I can understand how certain medications or surgeries can affect sexual health. So anything can affect your sexual health – the death of a family member, a history of trauma, depression, anxiety, or PTSD.
So think about whether you are running away from, say, a tiger. Do you want to have an erection then, or do you want to have an orgasm then? No. You will get eaten. So we’re not meant to be sexual beings every moment of the day, and so really, it’s about understanding what’s going on in your life from a biopsychosocial perspective and how that might affect sexual health .