Psychologist Wants Better Treatment For Women With Sexual Disorders

Hypoactive Sexual Desire Disorder is a condition in which women and men have low sex drives. But psychologist Lorri Brocco says the condition is too largely based on male sensibilities. As a result, Brocco wants the The American Psychiatric Association to publish a revised Diagnostic and Statistical Manual of Mental Disorders in the next few years.

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MICHEL MARTIN, host:

I'm Michel Martin, and this is TELL ME MORE from NPR News. Now it's time to go Behind Closed Doors. That's the part of the program where we talk about things that people often find difficult to talk about because of stigma or shame. Today, though, we're talking about something that we actually seem to talk about a lot but apparently don't really understand: women's sexual desire.

In a few minutes, we'll talk to the author of a new play set in the Victorian era, a time when many women and men really did not understand their own bodies, were not encouraged to, and many women had no idea that sexual feeling was even possible, let alone desirable. The play is called "In the Next Room," and we'll hear more about it in a few minutes.

But first, what is desire? Why do we have it? Why does it fade? Why do some women seem to have none at all? It turns out we know far too little about this subject and much of what we do know seems to be informed by male sensibilities. The American Psychiatric Association is preparing to publish a revised Diagnostic and Statistical Manual of Mental Disorders in the next few years, and as part of that effort is trying to better define something called hypoactive sexual desire disorder in women.

Psychologist Lorri Brocco is leading that effort. Her work was profiled in the New York Times Magazine recently, and she's with us now. Welcome, thank you for joining us.

Ms. LORRI BROCCO: Thank you very much for having me.

MARTIN: Before I continue, I should mention that this is a conversation about sex, which some people may not find appropriate for their present circumstances. So if that's the case, this is a good time to take a break and come back and see us in a few minutes.

So that being said, what is hypoactive sexual desire disorder, and what's wrong with the way it's defined now?

Ms. BROCCO: So, hypoactive sexual desire disorder, we often term it HSDD for short, is officially defined as a lack or deficiency in fantasies or desire for sexual activity.

Now, that was the definition according to the last edition of the Diagnostic and Statistical Manual, DSM IV. And as you noted a few moments ago, we're currently working on revising those definitions for DSM V, because we recognize that that definition is very highly problematic.

First of all, the focus on the lack of fantasy is highly problematic because when we interview women, and this has been done in a number of studies, as well as our experience working with women in the clinical setting, is that they don't necessarily talk about fantasies as being a hallmark sign of whether or not they have desire. In fact, many women will often say that they deliberately bring up fantasies in their mind as a way of focusing on the sexual situation, promoting desire, becoming aroused.

The second problem with the definition, desire for sexual activity, stems from the finding that there may be any number, in fact several hundred different reasons why women might engage in sexual activity, and very often it may have nothing at all to do with desire. It may relate to not being in the mood in the present but wanting to become in the mood, wanting to please a partner, wanting to experience emotional connection, and the list goes on and on.

MARTIN: One of the things I learned from this piece, profiling your work, is that there really is not as much data-driven information about women's sexuality as one might think, sexuality in general, and women's sexuality in particular. I'm curious about why that is, given how - I don't want to say sex-saturated - but sex-exposed we are, how much sexuality is a part of our public conversations these days.

Ms. BROCCO: I think where researchers have done a very good job, and I must say that we could probably credit the approval of Viagra in the U.S. in 1998 for the spotlight being turned onto women. And so with the approval of Viagra in men, it's caused many clinicians and researchers, and women themselves to say, hey, what about us?

So there has been quite a resurgence in research looking at women's sexuality, but over the last decade, it has mostly focused on how common are these problems? What are the kinds of things that predict these problems? And where we're really failing far behind is in effective treatments for women.

The pendulum, I think, is starting to swing now. There's certainly increasing pharmaceutical interest, and there's also been a tiny increase in more non-medication or psychological, psycho-educational alternative, et cetera, techniques for improving women's sexuality. Those are really still in its infancy.

Part of the limitation, as well, relates to funding. And as you introduced the show as being, you know, a taboo topic, something that despite us being so saturated with it in the culture, it's still something that causes us a great deal of discomfort. As a result of that, funding is not terrific.

So that certainly limits the kind of research and the scope of the research that we can do. But again, my prediction is that I think things are starting to change. The World Health Organization recognized sexual health as a fundamental component of health. And so, I think we may start to see the pendulum continuing to shift in that direction over the next decade.

MARTIN: Lorri Brocco is a psychologist in Vancouver, Canada. She is considered one of the world's leading specialists in hyposexual desire disorder in women. She was kind enough to join us from the Canadian Broadcasting Corporation studio in Vancouver. Lorri Brocco, thank you so much for speaking with us.

Ms. BROCCO: Thank you very much, Michel.

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