Hyposexual Desire Disorder, the media, and THE BRAIN.

There's a story that's been flying around the internet (I saw the first bits this morning), that a group of scientists have found changes in brain activity associated with hyposexual desire disorder. Dr Petra and Maria Wolters and I got to chatting about it on Twitter, and wanting to find out what to REALLY think, we all went in search of the paper.

And this is where I got something that got my goat SO BAD.

The paper ISN'T OUT YET. The paper ISN'T WRITTEN YET. THERE IS NO PAPER. What there is, as far as I can tell, is an abstract presented at a very recent meeting.


First off though, what are we looking at and why are we interested in it.

HSDD, Hypoactive Sexual Desire Disorder, is listed in the DSM-IV under sexual disorders and refers to:

So yes, a deficiency or absence of sexual desire or activity. It's mostly the desire that's important. Many people assume this applies only to women, but it does in fact apply to men as well (though women probably suffer from it more often). Basically, it's problems with sexual desire that are NOT related to anatomy or physiology.

HSDD is as yet ill defined (though there are over 23,000 results for it in Pubmed, but I would also note that for that results you also get results like 'when size matters: a clinical review of pathological micropenis'), but I mostly just see it defined as low rankings in various scorings, such as The Sexual Function Questionnaire (pdf). I haven't really seen things like actual NUMBERS on how often people with HSDD prefer to have sex compared to people without HSDD. So while I firmly believe the disorder exists, I'm not so sure how often or how WELL it is diagnosed. What are normal sex and desire levels for women, anyway? I still haven't found THAT study.

HSDD has been in the news a good deal lately because of a drug called flibanserin. Flibanserin was originally marketed as an antidepressant, but several patients noticed improvements in libido, and studies got underway to investigate it to treat symptoms of HSDD in women. You see, traditional libido enhancers like Viagra generally do not work in women. Viagra treats a physical underlying cause of erectile dysfunction (the inability to keep blood in the penis during an erection, usually due to lack of elasticity in blood vessels). But people with HSDD do not HAVE a physical basis for their lack of libido, and so this drug isn't going to work. Flibanserin showed a little more promise, because it acted as an antidepressant. But IF it improves libido (and the improvements they showed were very slight and highly variable, as in '8-83% showed improvement'), they aren't sure how. The drug was rejected by the FDA in the US, and I think it's a smart decision. Not only were the results unconvincing, the pharma company trying to get it approved had already set up a website to market it, fully prepared to press a full on selling campaign for treatment of a disorder which most people do not have.

But that's not what we're concerned about right now. What we're concerned about is the latest study on hypoactive sexual desire disorder. This study appears to be by Woodard et al, from Wayne State University. I got access to the abstract, but it's being presented at a meeting, it's not a paper. The abstract, from what I can tell, used functional magnetic resonance imagining to look at women with and without HSDD, during normal states and while viewing sexually explicit video clips. They found some differences between the women with HSDD and the women without, differences in brain area activation when viewing the sexually explicit clips.

Ok, that's fine. I'd still like to see the study. It seems like a fine study, if a bit of a fishing expedition (put them in, look at brain activation, call it quits). Because it just shows differences in brain area activation, it doesn't really TELL us anything about the women viewing these clips. How did the women FEEL about the sexually explicit clips? How were the clips chosen? What on earth do these differences in brain activation actually mean?

And here's where we run into the issue. Someone got this abstract out to the press, and the press talked about how this means women with HSDD have a physical basis of a disorder. Yeah...so? Different areas of brain activation can show...different areas of brain activation. Maybe these women react to these clips with disgust. Maybe they have memories triggered by the clips. There are many other thing. Sure, HSDD probably does have a physical basis in the brain, but SO DOES EVERYTHING. Everything you have ever experienced has changed something in your brain, and leaves its mark somehow. I suppose this is interesting because it goes against the grain. People assume that if you have a sexual dysfunction, it must be...where your sexual is. The fact that a lot of "your sexual" is IN your brain probably catches some people by surprise.

I'll go ahead and say I don't think the press did a bad job. They went with what they had, said there's probably a physical basis for the disorder in the brain (which, eventually, we will probably find there is), and that's that. But the paper's not out yet, and this abstract is big news, and it looks like there's nobody who has the real story and the real data to cover it well. And the reality is that, much as people like to talk about a "physical basis", there is no evidence here that is linked with FUNCTION. These abstract appears to be a fishing expedition that tells us nothing about women with HSDD, except that they might have more activation in the parietal lobe. It doesn't really give us anything to go on, any way to look into a cure or at least a cause.

But I'll wait until I see the paper. I'm withholding final judgment until then, but based on the abstract, I wouldn't get too excited.

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