In the case of acquired/situational HSDD, possible causes include intimacy difficulty, relationship problems, sexual addiction, and chronic illness of the man's partner.
[citation needed] Additionally, factors such as relationship problems or stress are believed to be possible causes of reduced sexual desire in women.
[citation needed] In the DSM-5, male hypoactive sexual desire disorder is characterized by "persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies and desire for sexual activity", as judged by a clinician with consideration for the patient's age and cultural context.
[4] For both diagnoses, symptoms must persist for at least six months, cause clinically significant distress, and not be better explained by another condition.
Sometimes problems occur because people have unrealistic perceptions about what normal sexuality is and are concerned that they do not compare well to that, and this is one reason why education can be important.
If the clinician thinks that part of the problem is a result of stress, techniques may be recommended to more effectively deal with that.
Also, it can be important to understand why the low level of sexual desire is a problem for the relationship because the two partners may associate different meanings with sex but not know it.
[2] A few studies suggest that the antidepressant, bupropion, can improve sexual function in women who are not depressed, if they have HSDD.
[18] The term "frigid" to describe sexual dysfunction derives from medieval and early modern canonical texts about witchcraft.
[19] Only in the early nineteenth century were women first described as "frigid", and a vast literature exists on what was considered a serious problem if a woman did not desire sex with her husband.
[21] Additionally, in the third edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-III), frigidity and impotence were cited as alternate nomenclatures for Inhibited Sexual Excitement.
[22] In 1970, Masters and Johnson published their book Human Sexual Inadequacy[23] describing sexual dysfunctions, though these included only dysfunctions dealing with the function of genitals such as premature ejaculation and impotence for men, and anorgasmia and vaginismus for women.
Prior to Masters and Johnson's research, female orgasm was assumed by some to originate primarily from vaginal, rather than clitoral, stimulation.
[25] In that year, sex therapists Helen Singer Kaplan and Harold Lief independently of each other proposed creating a specific category for people with low or no sexual desire.
The primary motivation for this was that previous models for sex therapy assumed certain levels of sexual interest in one's partner and that problems were only caused by abnormal functioning/non-functioning of the genitals or performance anxiety but that therapies based on those problems were ineffective for people who did not sexually desire their partner.
Within this context, people who were habitually uninterested in sex, who in previous times may not have seen this as a problem, were more likely to feel that this was a situation that needed to be fixed.
In addition to this subdivision, one reason for the change is that the committee involved in revising the psychosexual disorders for the DSM-III-R thought that the term "inhibited" suggests psychodynamic cause (i.e., that the conditions for sexual desire are present, but the person is, for some reason, inhibiting their own sexual interest).
Furthermore, the criterion that 6 symptoms be present for a diagnosis helps safeguard against pathologizing adaptive decreases in desire.
[44] Unnecessarily medicating asexual people for HSDD could be described as conversion therapy, so the individual needs to be prompted to examine the cause of their distress.
[48] Similarly, a frequency criterion (i.e., the symptoms of low desire be present in 75% or more of sexual encounters) has been suggested.
[49][50] The current framework for HSDD is based on a linear model of human sexual response, developed by Masters and Johnson and modified by Kaplan consisting of desire, arousal, orgasm.
Several criticisms were based on the inadequacy of the DSM-IV framework for dealing with females' sexual problems.