Clayton Anita H, Kingsberg Sheryl A, Goldstein Irwin
Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA.
OB/GYN Behavioral Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA.
Sex Med. 2018 Jun;6(2):59-74. doi: 10.1016/j.esxm.2018.01.004. Epub 2018 Mar 6.
Hypoactive sexual desire disorder (HSDD) often has a negative impact on the health and quality of life of women; however, many women do not mention-let alone discuss-this issue with their physicians. Providers of gynecologic services have the opportunity to address this subject with their patients.
To review the diagnosis and evidence-based treatment of low sexual desire in women with a focus on strategies that can be used efficiently and effectively in the clinic.
The Medline database was searched for clinically relevant publications on the diagnosis and management of HSDD.
HSDD screening can be accomplished during an office visit with a few brief questions to determine whether further evaluation is warranted. Because women's sexual desire encompasses biological, psychological, social, and contextual components, a biopsychosocial approach to evaluating and treating patients with HSDD is recommended. Although individualized treatment plan development for patients requires independent medical judgment, a simple algorithm can assist in the screening, diagnosis, and management of HSDD. Once a diagnosis of HSDD has been made, interventions can begin with office-based counseling and progress to psychotherapy and/or pharmacotherapy. Flibanserin, a postsynaptic 5-hydroxytryptamine 1A agonist and 2A antagonist that decreases serotonin levels and increases dopamine and norepinephrine levels, is indicated for acquired, generalized HSDD in premenopausal women and is the only agent approved in the United States for the treatment of HSDD in women. Other strategies to treat HSDD include using medications indicated for other conditions (eg, transdermal testosterone, bupropion). Bremelanotide, a melanocortin receptor agonist, is in late-stage clinical development.
Providers of gynecologic care are uniquely positioned to screen, counsel, and refer patients with HSDD. Options for pharmacotherapy of HSDD are currently limited to flibanserin, approved by the US Food and Drug Administration, and off-label use of other agents. Clayton AH, Kingsberg SA, Goldstein I. Evaluation and Management of Hypoactive Sexual Desire Disorder. Sex Med 2018;6:59-74.
性欲减退障碍（HSDD）常常对女性的健康和生活质量产生负面影响；然而，许多女性甚至都不会向医生提及这个问题，更不用说进行讨论了。妇科服务提供者有机会与患者探讨这个话题。
回顾女性性欲低下的诊断和循证治疗，重点关注可在临床中高效且有效地使用的策略。
检索Medline数据库，查找有关HSDD诊断和管理的临床相关出版物。
通过在门诊就诊时询问几个简短问题来完成HSDD筛查，以确定是否需要进一步评估。由于女性的性欲包含生物、心理、社会和情境等多个方面，因此建议采用生物心理社会方法来评估和治疗HSDD患者。虽然为患者制定个性化治疗方案需要独立的医学判断，但一个简单的算法可协助进行HSDD的筛查、诊断和管理。一旦确诊为HSDD，干预措施可从门诊咨询开始，逐步进展到心理治疗和/或药物治疗。氟班色林是一种突触后5-羟色胺1A激动剂和2A拮抗剂，可降低血清素水平并增加多巴胺和去甲肾上腺素水平，适用于绝经前女性获得性、全身性HSDD，是美国唯一获批用于治疗女性HSDD的药物。治疗HSDD的其他策略包括使用针对其他病症的药物（如透皮睾酮、安非他酮）。黑素皮质素受体激动剂布雷美拉诺肽正处于临床开发后期。
妇科护理提供者在筛查、咨询和转诊HSDD患者方面具有独特优势。目前HSDD的药物治疗选择仅限于美国食品药品监督管理局批准的氟班色林以及其他药物的非标签使用。克莱顿·A·H、金斯伯格·S·A、戈尔茨坦·I。性欲减退障碍的评估与管理。性医学2018；6：59 - 74。
