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Mayo Clin Proc. 2018 Apr;93(4):467-487. doi: 10.1016/j.mayocp.2017.11.002. Epub 2018 Mar 12.

The International Society for the Study of Women's Sexual Health Process of Care for Management of Hypoactive Sexual Desire Disorder in Women.

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Department of Psychiatry and Neurobehavioral Sciences and Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA.
Sexual Medicine Program, Alvarado Hospital, San Diego, CA.
Institute for Sexual Medicine, San Diego, CA. Electronic address:
Professor Emeritus, Case Western Reserve University School of Medicine, Cleveland, OH; Center for Marital and Sexual Health of South Florida, West Palm Beach, FL.
Women's Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, MN.
Women's Institute for Sexual Health, Nashville, TN.
Department of Psychiatry and Department of Medicine, Weill Cornell Medicine, New York, NY.
Department of Obstetrics and Gynecology, George Washington University, Washington, DC.
Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy.
Park Nicollet Sexual Medicine and Male Infertility Clinic, St. Louis Park, MN.
School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta, GA.
Department of Reproductive Biology, Case Western Reserve University School of Medicine, Cleveland, OH; Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH.
Institute for the Study of Urological Diseases, Thessaloniki, Greece.
Lisa Larkin, MD, and Associates, Mariemont, OH.
Institute for Health & Ageing, Melbourne, Victoria, Australia.
Department of Family Medicine, SUNY Downstate Medical Center, Brooklyn, NY.


The International Society for the Study of Women's Sexual Health process of care (POC) for management of hypoactive sexual desire disorder (HSDD) algorithm was developed to provide evidence-based guidelines for diagnosis and treatment of HSDD in women by health care professionals. Affecting 10% of adult females, HSDD is associated with negative emotional and psychological states and medical conditions including depression. The algorithm was developed using a modified Delphi method to reach consensus among the 17 international panelists representing multiple disciplines. The POC starts with the health care professional asking about sexual concerns, focusing on issues related to low sexual desire/interest. Diagnosis includes distinguishing between generalized acquired HSDD and other forms of low sexual interest. Biopsychosocial assessment of potentially modifiable factors facilitates initiation of treatment with education, modification of potentially modifiable factors, and, if needed, additional therapeutic intervention: sex therapy, central nervous system agents, and hormonal therapy, guided in part by menopausal status. Sex therapy includes behavior therapy, cognitive behavior therapy, and mindfulness. The only central nervous system agent currently approved by the US Food and Drug Administration (FDA) for HSDD is flibanserin in premenopausal women; use of flibanserin in postmenopausal women with HSDD is supported by data but is not FDA approved. Hormonal therapy includes off-label use of testosterone in postmenopausal women with HSDD, which is supported by data but not FDA approved. The POC incorporates monitoring the progress of therapy. In conclusion, the International Society for the Study of Women's Sexual Health POC for the management of women with HSDD provides a rational, evidence-based guideline for health care professionals to manage patients with appropriate assessments and individualized treatments.

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