Hypoactive sexual desire disorder (HSDD) is not “female erectile dysfunction (ED)”: challenges with the characterization of HSDD in women based on a systematic literature review

Abstract

Objective

Hypoactive sexual desire disorder (HSDD) in women has been viewed inaccurately by some in the medical and payer community as analogous to erectile dysfunction (ED) in men. This literature review aims to highlight the distinctions between HSDD and ED.

Methods

Two systematic literature searches were conducted on the epidemiology, symptomatology and biopsychosocial outcomes of HSDD and ED. Studies published since 2007 were considered for HSDD; studies published since 2012 were considered for ED.

Results

HSDD in women is primarily a central nervous system condition related to neuroendocrine factors, whereby neural pathways that regulate sexual excitation and/or inhibition appear to be involved. A combination of organic and psychogenic factors often contributes to ED. HSDD and ED are associated with similar psychological and interpersonal consequences, but affect different phases of the sexual response model (desire versus arousal) and have different pathophysiologies, therefore requiring different treatment and outcome paradigms. ED is measured by objective, physiological responses (erection and sexual function), but quantitative assessments for HSDD are more difficult because loss of desire with associated distress has to be assessed. Outcome measures used to assess ED, such as the number of satisfying sexual events, are far less informative as an endpoint for randomized clinical trials of treatments for HSDD.

Conclusions

HSDD and ED are distinct conditions affecting different phases of the sexual response model, and thus require clear and unique clinical characterization and adequate communication between the health care professional and patient for appropriate diagnosis, management and treatment.

Keywords:

• Erectile dysfunction
• female sexual dysfunction
• female sexual interest/arousal disorder
• hypoactive sexual desire disorder

Transparency

Declaration of funding

This study was sponsored by AMAG Pharmaceuticals, Inc., the licensee of bremelanotide. Additional support in the preparation of this manuscript was provided by Phase Five Communications, funded by AMAG Pharmaceuticals, Inc.

Declaration of financial/other relationships

S.A.K. has disclosed that she has served on advisory boards or has been a consultant for AMAG Pharmaceuticals, Inc., Astellas Pharma, Daré Bioscience, Duchesnay, Emotional Brain, Endoceutics Inc., Lupin Pharmaceuticals, Inc., Materna, Mitsubishi Tanabe Pharma America, Ovaco, Palatin Technologies, Inc., Pfizer Inc., Shionogi Inc., Strategic Science & Technologies LLC and TherapeuticsMD Inc.; she has stock options in Viveve Medical. S.N. and N.H. have disclosed that they are employees of Trinity Life Sciences, which has conducted research for AMAG Pharmaceuticals, Inc. S.K. has disclosed that she is a former employee of Trinity Life Sciences, which has conducted research for AMAG Pharmaceuticals, Inc. M.L.W. and L.A.W. have disclosed that they were employees of AMAG Pharmaceuticals, Inc. at the time of preparation of this manuscript. J.K. has disclosed that she is an employee and shareholder of AMAG Pharmaceuticals, Inc.

A CMRO peer reviewer on this manuscript has disclosed that she/he works in ED drug development. Peer reviewers on this manuscript have no other relevant financial or other relationships to disclose.

Author contributions

All authors were responsible for all of the content and editorial decisions, and received no honoraria related to the development of this manuscript. All authors contributed to the research, writing and reviewing of all drafts of this manuscript, and approved the final version.

Acknowledgements

Editorial support in the preparation of this manuscript was provided by Phase Five Communications, funded by AMAG Pharmaceuticals, Inc.

Previous presentation

Portions of this manuscript were presented as an abstract and a poster. Kingsberg S, Al-Khateeb Z, Karkare S, et al. Hypoactive sexual desire disorder (HSDD) is not “the female erectile dysfunction (ED)”: challenges with the characterization of HSDD in women. International Society for Pharmacoeconomics and Outcomes Research (ISPOR); 2018 May 19–23; Baltimore, MD, USA.

Notes

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