Asexual Explorations

Hypoactive Sexual Desire Disorder

In the third edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-III) published in 1980 by the American Psychiatric Association, the diagnosis Inhibited Sexual Desire (ISD)--a diagnosis that regarded lack of interest in sex as a mental disorder--was added. In DSM-III-R (1987), the name of this diagnosis was changed to Hypoactive Sexual Desire Disorder. In DSM-IV-TR it was changed to say that it was only a disorder if it caused marked distress or interpersonal difficulty. The relationship between this diagnosis and asexuality is an area that is yet to be explored in great detail. The following bibliography is designed to be helpful for those interested in a) the history/evolution of this diagnosis and its relationship to asexuality (broadly understood.)

The creation and evolution of ISD/HSDD

This diagnosis was independently proposed in two papers published in 1977:

  • Lief, H. (1977). Inhibited sexual desire. Medical Aspects of Human Sexuality, 7, 94-95.
  • Kaplan, H.S. (1977). Hypoactive sexual desire. Journal of Sex & Marital Therapy, 3 (1), 3-9.
  • Kaplan has written quite a bit on the topic. The following book has some useful historical information and provides a good idea of Kaplan's beliefs about sexuality and the ideology underlying regarding HSDD as a disorder.

  • Kaplan, H.S. (1995). The Sexual Desire Disorders. New York: Taylor & Francis Group.
  • In their introduction to the 1988 book Sexual Desire Disorders, Leiblum and Rosen provide an interesting perspective of the cultural background of this diagnosis. The book itself is also a valuable source of clinical perspectives on dealing with low sexual desire at the time.

    Leiblum, S.R., Rosen, R.C. (1988) Introduction: Changing Perspective on Sexual Desire. in ed. Leiblum, S.R., Rosen, R.C., Sexual Desire Disorders. pp. 1-15.

    The DSM-IV Sourcebook is a very useful source of information, both because of the references provided in the literature reviews and because of the explanations given of changes from DSM-III-R to DSM-IV.

  • Schiavi, R. C. (1996) Sexual Desire Disorders. in ed. Widiger, T.A., Frances, .,J. Pincus, H.H., Ross, R., First, M.B., Davis, W.W., DSM-IV Sourcebook vol. 2.
  • Davis, D. and Herdt, G. (1996). Cultural Sensitivity and the Sexual Disorders. in Widiger, T.A., Frances, .,J. Pincus, H.H., Ross, R., First, M.B., Davis, W.W. (eds)., DSM-IV Sourcebook vol. 4.
  • Davis, who wrote the above cited article, wrote a retrospective piece on her frustrations at what she perceived as a lack of cross-cultural consideration in the Sexual and Gender Identity disorders in DSM-IV, and she discusses the suggestions she made, and what was and was not accepted.

  • Davis, D. L. (1998). The sexual and gender identity disorders. Transcultural Psychiatry, 35, 401-412.
  • Prior to DSM-IV, ISD/HSDD did not require distress to be diagnosed because lack of interest in sex was defined to be an impairment (see Spitzer, Williams, & Skodol, 1980; and Spitzer 1981, cited below). However, since DSM-IV, "marked distress or interpersonal difficulties" (a clinical significance critera0 has been required for a diagnosis of HSDDl. Clinical significance criteria and reasons for their inclusion in the DSM are discussed in the following:

  • Spitzer, R. L., & Wakefield, J. C. (1999). DSM-IV diagnostic criteria for clinical significance: Does it help solve the false positive problem? American Journal of Psychiatry, 156, 1865-1864.
  • Since the late 1990's, there has been considerable research and controvercy regarding what has been called Female Sexual Dysfunction. The following is an important paper on the matter. Also, the issue of the Journal of Sex and Marital Therapy in which it appeared contains a number of commentaries that help to understand various perspectives in the field on the matter.

  • Basson, R., Berman, J., Burnett, A., Derogatis, L., Ferguson, D., Fourcroy, J., Goldstein, I., Graziottin, A., Heiman, J., Laan, E., Leiblum, S., Padma-Nathan, H., Rosen, R., Segraves, K., Segraves, R. T., Shabsigh, R., Sipski, M., Wagner, G., Whipple, B. (2001). Report of the international concensus development conference on female sexual dysfunction: definitions and classifications. Journal of Sex and Marital Therapy 27 (2) pp. 83-94
  • The DSM-5 Literature Reviews for the Sexual Dysfunctions have been published online, and their historical value is obvious. Significantly, they are proposing to rename this diagnosis to Sexual Interest/Arousal Disorder and make different diagnoses for males and females. There is, at present, no report of Male Hypoactive Sexual Desire Disorder. According to, there has not been much published on the matter.

  • Brotto, L.A. (2010). The DSM Diagnostic Criteria for Hypoactive Sexual Desire Disorder in Women. Archives of Sexual Behavior, 39, 221-239.
  • Brotto, L. A. (2010). The DSM diagnostic criteria for hypoactive sexual desire disorder in men. Journal of Sexual Medicine, 7, 2015-2030.
  • Graham, C. A. (2010). The DSM Diagnostic Criteria for Female Sexual Arousal Disorder. Archives of Sexual Behavior, 39, 240-255.
  • There is relatively little published in terms of historiography of this diagnosis, but there is some.

  • Segraves, R., Balon, R., & Clayton, A. (2007). Proposal for changes in diagnostic criteria for sexual dysfunctions. Journal of Sexual Medicine, 4 (3), 567-580.
  • Segraves, R. & Woodard, T. (2006). Female Hypoactive Sexual Desire Disorder: History and Current Status. Journal of Sexual Medicine, 3, 408-418
  • Irvine, Janice (2005) Disorders of Desire. Temple University Press. Chapter 7.
  • Another history of them is found on Asexual Explorations Blog: Hypoactive Sexual Desire Disorder and the Asexual Community: A History.

    The relationship between the medicalization of homosexuality, the paraphilias and homosexuality
    In my own research on the matter, I have found a closer relationship for these than I had once assumed.

    The first two references do not address the matter directly, but are extremely valuable for understanding the historical context.

  • Bayer, R. (1987). Homosexuality and American Psychiatry: The politics of diagnosis. Princeton University Press.
  • Bayer, R. & Spitzer, R. L. (1982). Edited corresondance on the status of homosexuality in DSM-III. Journal of the history of the behavioral sciences, 18, 32-52.
  • In discussions of the DSM's definition of mental disorder and the status of homosexuality, both the sexual dysfunctions and the paraphilias are compared for reference, in some rather interesting ways. Also, Kaplan and Lief's article proposing the diagnosis have revealing comments as well.

  • Anonymous. (1973, December 23.) The issue is subtle, the debate is still on. New York Times. p. 109.
  • Kaplan, H.S. (1977). Hypoactive sexual desire. Journal of Sex & Marital Therapy, 3 (1), 3-9.
  • Lief, H. (1977). Inhibited sexual desire. Medical Aspects of Human Sexuality, 7, 94-95.
  • Spitzer, R. L., Williams, J. B. W., and Skodol, A. E. (1980) DSM-III: The major achievements and an overview. American Journal of Psychiatry, 137, 151-164.
  • Spitzer, R. L. (1981). The diagnostic status of homosexuality in DSM-III: A reformulation of the issues. American Journal of Psychiatry, 138, 210-215.
  • Spitzer, R. L., & Williams, J. B. W. (1982). The definition and diagnosis of mental disorder. In W. R. Gore (Ed.), Deviance and mental illness (pp. 15-31). Beverly Hills, CA: Sage.
  • Articles specifically dealing with asexuality and HSDD

    Criticisms of ISD/HSDD certainly preceded recent controversies regarding female sexual dysfunction (and the classification of sexual dysfunctions/problems more generally), but they have substantially grown in quantity since about 1998. In discussions on these topics, there has been an increase in the recognition of asexuality and how this should inform the discussion. The following are articles that at least raise these questions.

    The first set of articles here are ones specifically about asexuality (all of which are also listed on the existing research page) that are not specifically about HSDD/sexual dysfunction and its relationship to asexuality, but they all address the matter, often raising more questions than they answer.

  • Bogaert A.F. (2004) Asexuality: Its Prevalence and Associated Factors in a National Probability Sample. Journal of Sex Research, 41, 279-287
  • Bogaert A. F. (2006). Toward a Conceptual Understanding of Asexuality. Review of General Psychology, 10, 241-250
  • Prause, N & Graham, C. A. (2007) Asexuality: Classification and Clarification. Archives of Sexual Behavior, 36, 341-35
  • Scherrer, K. (2008). Asexual Identity: Negotiating Identity, Negotiating Desire. Sexualities, 11, 621-641
  • Hinderliter, A.C. (2009) Methodological Issues for Studying Asexuality. Archives of Sexual Behavior. 38. 619-621
  • Brotto, L. A., Yule, M. A. (2009) Reply to Hinderliter. Archives of Sexual Behavior. 38. 622-623
  • In addition to these, a few articles not primarily about asexuality have included mention of asexuality in their discussion of these issues.

  • Balon, R. (2008).l The DSM Criteria of Sexual Dysfunction: Need for a Change. Journal of Sex and Marital Therapy, 34, 186 - 197.
  • Hill, N. L. (2009). Affirmative Practice and Alternative Sexual Orientations: Helping Clients Navigate the Coming Out Process. Clinical Social Work Journal, 37, 346-356.
  • Jutel, A. (2010). Framing disease: The example of female hypoactive sexual desire disorder. Social Science & Medicine, 70, 1084-1090.
  • Leiblum S. R. (ed). Treating Sexual Desire Disorders: A Clinical Casebook.
  • For the above, it is the editor's introduction that discusses asexuality.

    Other criticisms of HSDD and related conceptualizations

    Apfelbaum, B. (1988) An ego-analytic perspective on desire disorders. in Leiblum, S.R., Rosen, R.C. (eds.) , Sexual Desire Disorders.

  • Apfelbaum, B., (1984) Sexual reality and how we dismiss it.
  • Anderson, A. (2005). Is Lack of Sexual Desire a Disease? Is Testosterone the Cure? Medscape Ob/Gyn & Women's Health, 10. Available at:
  • Tiefer, L. (2004). Sex is not a natural act & other essays (2nd ed.). Boulder, CO: Westview Press.
  • Tiefer, L.; Hall, M. & Tavris, C. (2002) Beyond dysfunction: A new view of women’s sexual problems. Journal of Sex and Marital Therapy, 28 (s), 225-232
  • Related to this is the New View Campaign. For those who are interested, they provide a bibliography for Articles and Book Chapters Integrating The New View.

    Generally useful sources for background information
    For a general background to issues pertaining to sexology and and to psychiatric classification, I suggest the following, although they do not deal directly with the relevant issue. For information on sexology more generally, I strongly recommend the first two as a good starting place.

    Bullough, V. L. (1995). Science In The Bedroom: A History Of Sex Research. Basic Books.

  • Irvine, Janice (2005) Disorders of Desire. Temple University Press.
  • For those interested specifically in issues pertaining to psychiatric classification, the following are extremely helpful:

  • Bayer, R. (1987). Homosexuality and American Psychiatry: The politics of diagnosis. Princeton University Press.
  • Sadler, J. Z. (2005). Values and Psychiatric Diagnosis. Oxford: Oxford University Press.