Female lack of desire, arousal or pleasure from sex

What is ‘Female lack of desire, arousal or pleasure from sex’?

Female lack of desire, arousal or pleasure from sex is sometimes called Hypoactive Sexual Desire Disorder (HSDD) in the classical medical tradition. In this context, we are involved when a person with a with a vulva and vagina has this condition and it is causing them distress.

What must be established first

There are many reasons why a woman may have a lack of desire, arousal or pleasure from sex and it’s important to rule out any medical reasons before further psychosexual investigations take place. So if you have not spoken to your GP about the problem yet, you will be encouraged to do so. Your doctor will be skilled and experienced in the medical aspects and should put you at ease to talk about it. Once your GP has ruled out any underlying medical issues we can get to work.

Understanding the Context

How long has it been going on? Are other related problems happening? Do you smoke, drink, use recreational drugs or have lifestyle behaviours that can impact your relationship to sex? Has anything affected you in the past? How do you feel about your partner(s) if relevant? How does your partner(s) feel about you and your condition? Do you masturbate, and do you have any interest in porn? Importantly I seek to understand your relationship to sex, your sexual orientation, sexual script and whether you are intrinsically interested in sex. You may have no interest in sex but feel pressured to believe you should. The job of the sexologist is not to help falsely build interest when there is none, it’s to assist you to find comfort and acceptance in your unique orientation.

Understanding your perspective

We need to know what aspect of the problem is causing you the most distress. What are your underlying beliefs that inform this distress. If some ‘shoulds’ emerge there may be opportunities for challenge, re-framing and psycho-education. We are complex beings living in complex times and we can usually benefit from some self-compassion.

Teaching image male lack of desire, arousal or pleasure from sex schema


Once it has been clearly established that you want to achieve or regain desire, arousal or pleasure from sex (in line with The Memorandum of Understanding on Conversion Therapy in the UK) there are a number of exercises that can help you gain confidence, understanding of your unique arousal style and mastery of your habitual thought processes. If appropriate, these can support psychotherapeutic work to discover any underlying causes for your particular relationship with sex and intimacy.

If a loving and supportive partner is available then intimacy can be re-framed and explored safely. Sex is a varied relational practice.

Check whether access to porn has distorted your assessment of what’s achievable and expected. Porn is not a depiction of reality

It can be beneficial to prioritise attention on your own sensations rather than worrying about your performance or body image

How are your thoughts supporting you? Practice mindfulness and self affirmation. Don’t be a prisoner of past experiences. 

Get to know and increase what excites you and reduce what inhibits you. Care for your body. Experiment with sex toys

Remember:  Pleasurement not measurement! 

And by the way, you don't need to wait for a crisis.

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