Table 2.
| Step 1: Initiate the conversation using the PLISSIT model |
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Step 2: Utilize the screening tool: decreased sexual desire screener An answer of “yes” to the first four questions is consistent with HSDD Question 5 can identify reasons for the decrease in sexual desire |
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Step 3: Take a thorough sexual history considering psychosocial issues a. Relationship status b. History of abuse (verbal, emotional, physical, or sexual) c. Alcohol, tobacco, or illicit drug abuse |
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Step 4: Take a thorough sexual history considering medical/medication issues a. Current health status b. Past medical history c. Reproductive history and current status (age of menarche, menstrual history, obstetric history, infertility, contraception, sexually transmitted diseases, gynecologic problems, surgeries, urologic problems) d. Endocrine system (diabetes, thyroid disorders, hyperprolactinemia, androgen deficiency) e. Neurologic disorders f. Hypertension g. Psychiatric Illness (mood disorders, anxiety disorders, psychotic illness) h. Surgical history i. Medications (antidepressants, mood stabilizers, anticonvulsants, anticholinergics, opioids, amphetamines, hormones (estrogens, progestins), anti-androgens, GnRH agonists, antihypertensive agents (beta blockers, alpha blockers, diuretics), cardiovascular agents (triglyceride-lowering agents, digoxin), weight loss agents, histamine receptor blockers, chemotherapy agents, aromatase inhibitors, immunosuppressant therapies, steroids) j. Other chronic conditions (breast cancer, rheumatoid arthritis, psoriasis) |
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Step 5: Additional evaluation if needed a. Physical exam b. Gynecological examination c. Glycemic control d. Thyroid hormones e. Prolactin levels f. Testosterone and sex hormone binding globulin levels |
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Step 6. Refer to specialists if needed a. Certified sexual therapists b. Certified sexual counselors c. Psychiatrists or psychologists |
HSDD hypoactive sexual desire disorder, PLISSIT permission limited information specific suggestions intensive therapy