Decreased Sexual Desire Screener

What is the Decreased Sexual Desire Screener?

The Decreased Sexual Desire Screener (DSDS) is a validated five-item questionnaire for diagnosing generalized acquired hypoactive sexual desire disorder (HSDD) in premenopausal women. It provides a brief diagnostic procedure for healthcare providers who are neither trained nor specialized in female suxal dysfunction (FSD). The first four questions assess the patient's sexual desire and distress, while the fifth question identifies potential confounding factors.

The DSDS was validated in a multicenter study involving 263 women, comparing its diagnostic outcomes with those obtained from a standard diagnostic interview conducted by an expert clinician. The agreement rate was 85.2%, with a sensitivity of 83.6% and a specificity of 87.8% (Clayton et al., 2009), indicating its effectiveness in accurately diagnosing HSDD.

The DSDS is valuable in clinical settings with limited access to specialized expertise, providing a brief and straightforward method for non-expert clinicians to screen for HSDD. The inclusion of psychological factors in the fifth question is crucial, as these can significantly impact sexual desire and help clinicians provide a more comprehensive assessment and tailored treatment plan for female sexual dysfunction.

However, it is important to note that this screener is based on the DSM-IV, which was made obsolete in 2015 by the release of the 5th edition (DSM-5). HSDD has been merged with female sexual arousal disorder to form a single diagnosis called female sexual interest/arousal disorder (FSIAD).

Understanding hypoactive sexual desire disorder (HSDD)

Hypoactive sexual desire disorder (HSDD) is a condition where there is a persistent or recurrent deficiency or absence of sexual desire and fantasies, causing marked distress or interpersonal difficulty. Recognized in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), HSDD is often underdiagnosed and poorly treated due to sociocultural barriers and limited understanding among healthcare providers.

How to conduct the Decreased Sexual Desire Screener?

When conducting the Decreased Sexual Desire Screener, it's essential to approach the process thoughtfully to ensure the patient feels comfortable and supported. Here’s a streamlined guide to help you do it in your clinical practice:

Step 1: Access the template

Click "Use template" to open our Decreased Sexual Desire Screener template in the Carepatron, where you can customize it, print it, share it, or directly fill it. Alternatively, you can save a non-customizable but printable and fillable PDF version of the screener by clicking "Download."

Step 2: Prepare to administer the screener

First, read through the screener to ensure that you are familiar with its contents. Create a private setting where the patient feels safe to take the screener. Build rapport through casual conversation to ease any nervousness and reassure them about confidentiality.

Step 3: Administer the questionnaire

Ask the patient about the DSDS items directly or integrate them in an extensive diagnostic interview. Encourage detailed responses to each question about her past and current experiences. Remember, this is not a screener for self-diagnosis; it is meant to be part of a comprehensive diagnostic assessment.

Step 4: Discuss findings

Interpret the results and clarify what they mean. Provide supportive feedback on potential next steps for evaluation or treatment options. Take note that HSDD no longer exists in the DSM-5-TR and is now under female sexual interest/arousal disorder (FSIAD).

Scoring and interpreting

In the screener, the patient must answer "YES" to Questions 1-4, indicating an absence of desire. Additionally, for a valid diagnosis, the patient must respond "NO" to all factors listed in Question 5, which could potentially complicate the diagnosis, such as medical conditions, medications, or relationship issues.

A positive diagnosis of HSDD is confirmed when the patient answers "YES" to Questions 1-4 and "NO" to all factors in Question 5. If the patient answers "YES" to Questions 1-4 but also "YES" to any factors in Question 5, clinical judgment is required to assess the diagnosis further. Conversely, a negative diagnosis occurs if the patient answers "NO" to any of Questions 1-4.

However, as stated previously, this screener is based on DSM-IV. DSM5-TR requires the presence of at least three of six symptoms related to sexual interest and arousal, including reduced interest in sexual activity, sexual thoughts, and pleasure during sexual encounters. The DSDS only captures the criteria for desire but does not fully capture the broader criteria for FSIAD.

Next steps after conducting the test

After the screening, take the time to discuss the results thoroughly with the patient to ensure they understand their condition and address any concerns they may have. Do other tests to confirm a diagnosis of FSIAD. Then, depending on those results, consider creating a comprehensive treatment plan tailored to the patient's needs. This plan may include various therapeutic options, lifestyle changes, or medication.

Additionally, if the situation warrants, referring the patient to a specialist in sexual health or therapy can provide further support and expertise. Remember that continuous support and regular follow-up appointments are crucial for effectively managing low sexual desire, as they help monitor progress and make necessary adjustments to the treatment plan. Building a trusting relationship with the patient will also encourage open communication, making it easier for them to discuss any challenges they encounter in terms of sexual function.

Clayton, A. H., Goldfischer, E. R., Goldstein, I., DeRogatis, L., Lewis-D’Agostino, D. J., & Pyke, R. (2009). Validation of the Decreased Sexual Desire Screener (DSDS): A brief diagnostic instrument for generalized acquired female hypoactive sexual desire disorder (HSDD). The Journal of Sexual Medicine, 6(3), 730–738. https://doi.org/10.1111/j.1743-6109.2008.01153.x