Low desire and a diagnostic label

The apparent choice between dismissal and immediate medicalisation leaves little room for a woman to describe the problem.

The disputed boundary

A review of HSDD describes disagreement over diagnostic criteria and the medicalisation of sexuality. That is a dispute about the boundary around a diagnosis, with consequences for how low desire is understood.

The diagnostic boundary is consequential: a diagnosis can bring attention and also narrow the conversation. Neither possibility earns the whole conversation. Calling every variation a disorder would be a poor account of desire; dismissing a distressing problem as mere variation would be a poor account of the person describing it.

Illustration of two empty chairs, a closed notebook and a curved linen privacy screen. — An imagined conversation space, drawn for this essay; the chairs stand empty and no patient is depicted.

Sexual activity in the baseline records

A review of baseline data from HSDD trials reported sexual activity about 2.5 times per month among women with documented HSDD. The trials concerned testosterone, flibanserin and bremelanotide. The authors argued that this baseline activity could skew estimates when satisfying sexual events were the primary endpoint.

The title uses the phrase “mercy sex.” I distrust the motive that phrase smuggles into an encounter. The finding earns a place here for a more restrained reason: activity occurred in a population with a documented desire disorder. Counting encounters alone leaves the question of wanting incompletely answered.

That review concerns trial baseline data. It supplies neither a population-wide account of women's sexual lives nor a reason to assign the same motive to everyone in its source trials.

Responses to low desire

An expert round-table review of premenopausal HSDD emphasises patient choice and combined medical and psychological approaches. I prefer the breadth of that conversation to an argument that starts and ends with whether a molecule works.

The bremelanotide indication concerns generalized acquired HSDD in premenopausal women. That specificity remains relevant even when the larger debate is about women receiving attention. A wish for broader recognition cannot expand the population supported by a particular clinical record.

A diagnostic conversation ought to leave room for a person to describe the problem without the conclusion arriving ahead of her. The care-gap study makes recognition urgent; the trial results give a medication discussion something concrete to consider.