HSDD vs. Asexuality

[m4rble]

I was reading this article about HSDD(hypoactive desire disorder). 

https://www.psychologytoday.com/articles/201709/the-quest-lust?collection=1105674

It made me wonder about what the differences are between HSDD and asexuality are considering they're both defined by a lack of interest in sex. The article mainly talked about women who lost their sexuality as they got older; This is different from asexuality which is usually lifelong.

 

I was a bit confused by why lacking desire for sex was considered a disorder at all. If someone doesn't desire something, why should they be disturbed by its absence? Obviously some of the women were disturbed by its absence, but the article itself says not all of them were:

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We had a study where we looked at people who hadn't had an orgasm in a long time and didn't respond much sexually, and they said, 'It doesn't bother me.'

If some were clearly saying it wasn't a problem, why is it that still treated as a disorder for them? Someone who is simply unaware of their own asexuality could be dissatisfied with their own lack of sexuality simply due to social conditions, so I'm not seeing a huge difference here. 

 

It did say this though:

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 And no amount of neural tinkering, she says, can resolve the problem of simply being unattracted to someone. 

I suppose it could be argued that defining asexuality by attraction rather than desire would help differentiate it from HSDD. 

[Bri is Me]

10 minutes ago, m4rble said:

If some were clearly saying it wasn't a problem, why is it that still treated as a disorder for them? Someone who is simply unaware of their own asexuality could be dissatisfied with their own lack of sexuality simply due to social conditions, so I'm not seeing a huge difference here.

I think that this is considered a problem, especially by the medical community, because people with little to no sexual desire (desire may be the wrong word here) are not within "normal" ranges of what most people of their age, gender, ethnicity, etc experience.  I'd compare this to my own experience as a Hard of Hearing individual, as much of the Deaf community doesn't have a problem with being deaf.  We have learned to get along perfectly fine without the ability to hear, and so the Deaf community doesn't view deafness as being a disability.  But others, again, especially in the medical community, continue to consider deafness a disability and a problem that needs to be fixed because most people our ages can hear within "normal" ranges.

[malacat]

I think this just points out the problem with making lack of interest in sex a clinical issue. Because society sees it as "against the norm" a doctor might see it as something that needs to be fixed.

Society should be trying to break down this idea that people need to want sex to be normal and happy. The language surrounding people disinterested in sex needs to be changed. Sex is natural, but it's not for everyone. Whether someone wants or does not want it doesn't make someone more or less human.

That being said, there are some physical and mental health conditions that might make someone's interest in sex decrease. If there is a sudden disinterest in sex, accompanied by discomfort not caused by this change in mentality, then it could be worth looking into the cause of the change. Nevertheless, it should be up to the person on how they want to proceed. If this was normalized and treated as a natural thing, I think it would cause people a lot less distress.

[thedemiace]

The difference is that one is a disease that is connected to age and hormonal issues. The other is not connected to either. Be clear that the two show physiological, and even perhaps genetic reason. Also, it seems that HSDD might even be connected more to the female sex, while Asexuality isn't. The key-point, however, is the genitalia. Asexuals do feel arousal/sensation if they are masturbated. Some even masturbate. However, with HSDD, this doesn't happen. Also, the patient can be in the past sexual, or very sexual, and then he or she no longer is.

[m4rble]

4 minutes ago, thegrayace said:

The difference is that one is a disease that is connected to age and hormonal issues. The other is not connected to either. Be clear that the two show physiological, and even perhaps genetic reason. Also, it seems that HSDD might even be connected more to the female sex, while Asexuality isn't. The key-point, however, is the genitalia. Asexuals do feel arousal/sensation if they are masturbated. Some even masturbate. However, with HSDD, this doesn't happen. Also, the patient can be in the past sexual, or very sexual, and then he or she no longer is.

The fact that HSDD is associated with females might be a problem in and of itself. It's possible researchers are expecting female sexual desire to perfectly follow the male pattern when it often doesn't. 

 

Also, HSDD is not an arousal disorder, it's a desire disorder. The article goes into how arousal inducing drugs don't do anything for HSDD. 

 

[vega57]

35 minutes ago, m4rble said:

The fact that HSDD is associated with females might be a problem in and of itself. It's possible researchers are expecting female sexual desire to perfectly follow the male pattern when it often doesn't. 

Just to expand on your (very insightful) point here, I think that researchers may not only expect that female sexual desire "should" follow the male "pattern", but that ALL males are also expected to follow the exact same 'male' pattern.  If they don't, they're less 'male'. 

[thedemiace]

30 minutes ago, m4rble said:

The fact that HSDD is associated with females might be a problem in and of itself. It's possible researchers are expecting female sexual desire to perfectly follow the male pattern when it often doesn't. 

 

Also, HSDD is not an arousal disorder, it's a desire disorder. The article goes into how arousal inducing drugs don't do anything for HSDD. 

 

Males can also have this disease. However, perhaps you're right. Maybe these scientists consider that female should have the same sexual drive as men. It has been proved that men have a higher sex-drive than women. Men can even pregnant a woman at the age of 60's and 70's, while women no longer can be pregnant at this age.
The arousal is part of the signs and symptoms. The disorder expands also in sexual thoughts and desire as well. 
I also did my research in the disease, and is connected to other disease, like diabetes, cancer, arthritis, and other diseases. It has also been connected with estrogen and even testosterone reduction. Other factors can be emotional or psychological, like stress and depression. It can also be because of a medication that the patient is being taken as well. None of these are connected with asexuality.

[Pramana]

This is one of those thorny issues that splits along ideological lines, and for which there still isn't a perfect answer. Here's where things stand at the moment:

1. HSDD developed as a diagnosis in the 1970s/1980s, primarily for heterosexual women who reported declining levels of sexual desire in the context of long-term relationships with heterosexual men.
2. Asexuality was developed as a sexual orientation in the 2000s, by people with a (usually lifelong) lack of sexual attraction and/or sexual desire, and so weren't interested in having sex in the first place.

Research has shown that:

3. People who lack sexual attraction are more likely to report a stable lifelong lack of interest in sex, whereas people with acquired HSDD are more likely to experience a decline from a previous peak while still demonstrating higher levels of interest in sex than asexual people (and as a result of that interest, are more likely to feel that they would like to increase their sex drive).
4. There is potentially more overlap between lifelong HSDD and asexuality according to the sexual desires/fantasies/sexual interest matrices, adding to the rationale for placing emphasis on sexual attraction as the distinguishing feature. However, there are also some indications that the group of self-identified asexuals may include people who do experience sexual attraction but who lack sufficient sex-drive to act on those attractions.

Currently, the DSM-5 diagnostic criteria for HSDD are: lack of sexual desire, which causes distress, and which isn't better explained by the individual's self-identification as asexual (assumption being that asexuality concerns a lack of sexual attraction). Therefore,

5. If one feels distress about low sexual desire for whatever reason, but one also lacks sexual attraction, then the diagnostic criteria would recognize this as an orientation that can not and should not be changed, so the right approach would be to accept an asexual identity rather than trying to increase sexual desire.
6. If one feels distress about low sexual desire for whatever reason, and one does experience sexual attraction, then the diagnostic criteria would consider this HSDD and recommend treatments to increase sexual desire.
7. Note though that someone who experiences sexual attraction and who isn't distressed about their low sexual desire wouldn't be considered to either have HSDD or be asexual.

So what about?:

8. People who experience sexual attraction, have low sexual desire, and feel distressed because they are in a relationship with a sexual partner who wants more sex, but who wouldn't feel distressed otherwise.

Queer theorists have argued that #8 should be considered a form of asexuality, because in their view asexuality is at its core an identity developed to challenge compulsory sexuality and assumptions of sexual entitlement in relationships.

Behavioural psychologists don't like this because in their view asexuality is at its core about the non-experience of a psychological state (sexual attraction), and not how one feels about the non-experience of a psychological state (sexual desire) based on one's personality and political beliefs.

[Jewel Bright]

4 minutes ago, Pramana said:

Queer theorists... asexuality is at its core an identity developed to challenge compulsory sexuality and assumptions of sexual entitlement in relationships.

I would agree with this in my experience that everyone I tell about my identity (usually first) asks how it affects my partner.

[m4rble]

47 minutes ago, Pramana said:

Behavioural psychologists don't like this because in their view asexuality is at its core about the non-experience of a psychological state (sexual attraction), and not how one feels about the non-experience of a psychological state (sexual desire) based on one's personality and political beliefs.

I am not sure what this means exactly. In order for this to be a strict criteria of anything behavioral psychologists would need to have a clear definition of what sexual attraction is since different people think it means different things.

 

Considering some of the experiments psychologists perform, it would seem that many of them would define sexual attraction as sexual arousal in response to visual stimulus, but I think this has very applications to the real world and leads people to draw ridiculous conclusions.(i.e. there are no straight women. also, women are all secretly attracted to apes, who knew)

 

Also, I would say desire involves a bit more than a personal decision based on one's personality and political beliefs. 

[Jewel Bright]

5 minutes ago, m4rble said:

it would seem that many of them would define sexual attraction as sexual arousal in response to visual stimulus,

I also believe that the language that we use cannot access our disparate experiences. 

Since I didn't know there was another option, for a long time I explained my experiences with their words. It took me a long time to understand that we were talking about different things.

[Pramana]

8 minutes ago, m4rble said:

I am not sure what this means exactly. In order for this to be a strict criteria of anything behavioral psychologists would need to have a clear definition of what sexual attraction is since different people think it means different things.

 

Considering some of the experiments psychologists perform, it would seem that many of them would define sexual attraction as sexual arousal in response to visual stimulus, but I think this has very applications to the real world and leads people to draw ridiculous conclusions.(i.e. there are no straight women. also, women are all secretly attracted to apes, who knew)

 

Also, I would say desire involves a bit more than a personal decision based on one's personality and political beliefs. 

With sexual attraction, there are three components to the concept:
1. Physiological responses to erotic stimuli – tracks subjective mental reports of sexual arousal in men but not in women, because women exhibit category non-specific physiological arousal to sexual imagery of any type.
2. Sexual desires/feelings for other people – wanting to have sex with someone because that person possesses certain criteria (with sex/gender being the relevant criteria for orientation) that one finds arousing (emphasis on mental arousal, which may or may not be accompanied by physical arousal). Logically, a sexual orientation is something that orients your sexual desires towards certain types of people, so sexual attraction may be thought of as that subset of your sexual desires which are attached to concepts about other people.
3. The subjective state of having those feelings/desires – analogous to having a crush on someone, kind of a know it if you've felt it, if you have to ask then you probably haven't felt it, scenario.

For asexuality (and I think with sexual orientations more generally) the trend it to focus on #2-3 because of the issues identified with number #1. Brotto and colleagues found that asexual women exhibit the same category nonspecific sexual arousal to erotic imagery as sexual women, and used that as evidence to argue that asexual women don't have a physiological disorder.

[m4rble]

6 minutes ago, Pramana said:

With sexual attraction, there are three components to the concept:
1. Physiological responses to erotic stimuli – tracks subjective mental reports of sexual arousal in men but not in women, because women exhibit category non-specific physiological arousal to sexual imagery of any type.
2. Sexual desires/feelings for other people – wanting to have sex with someone because that person possesses certain criteria (with sex/gender being the relevant criteria for orientation) that one finds arousing (emphasis on mental arousal, which may or may not be accompanied by physical arousal). Logically, a sexual orientation is something that orients your sexual desires towards certain types of people, so sexual attraction may be thought of as that subset of your sexual desires which are attached to concepts about other people.
3. The subjective state of having those feelings/desires – analogous to having a crush on someone, kind of a know it if you've felt it, if you have to ask then you probably haven't felt it, scenario.

For asexuality (and I think with sexual orientations more generally) the trend it to focus on #2-3 because of the issues identified with number #1. Brotto and colleagues found that asexual women exhibit the same category nonspecific sexual arousal to erotic imagery as sexual women, and used that as evidence to argue that asexual women don't have a physiological disorder.

This is interesting, you seem to know quite a bit about asexual literature. It would seem that #2 literally is just sexual desire except maybe a bit more directed. So in that case, how is it possible to feel sexual attraction without feeling sexual desire? 

[Pramana]

31 minutes ago, m4rble said:

This is interesting, you seem to know quite a bit about asexual literature. It would seem that #2 literally is just sexual desire except maybe a bit more directed. So in that case, how is it possible to feel sexual attraction without feeling sexual desire? 

I did a bunch of research for a paper I'm writing on the topic, so I have a lot of notes on hand.

A sexual desire is a desire to engage in activities that affect physiological states of sexual arousal. Thus, a sexual desire is a type of desire, but is not a psychological state.

When psychologists talk about sexual attraction and sexual desire, they're talking about psychological states. Sexual desire refers to feeling horny, feeling sexual tension, feeling a need for sexual pleasure/orgasm, which gives rise to sexual desires to achieve those objectives. Sexual attraction refers to having sexual feelings for people, which gives rise to sexual desires that involve those people. This explains why sexual desires created by feeling horny can be relived through masturbation, whereas sexual desires caused by feelings of sexual attraction can only be addressed through partnered interaction.

[vega57]

 

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This explains why sexual desires created by feeling horny can be relived through masturbation, whereas sexual desires caused by feelings of sexual attraction can only be addressed through partnered interaction.

Not sure I agree with the bolded part.  I think sexual desires caused by feelings of sexual attraction can also be addressed through masturbation.  The psychological aspect may not be addressed, but the physical aspect certainly can. 

 

I mean, what if a sexual married man becomes sexually attracted  to woman other than his (hetero)sexual spouse?  Does that mean that the ONLY way he can address that attraction is with his 'target'? 

[Pramana]

29 minutes ago, vega57 said:

Not sure I agree with the bolded part.  I think sexual desires caused by feelings of sexual attraction can also be addressed through masturbation.  The psychological aspect may not be addressed, but the physical aspect certainly can. 

 

I mean, what if a sexual married man becomes sexually attracted  to woman other than his (hetero)sexual spouse?  Does that mean that the ONLY way he can address that attraction with his 'target'? 

The idea is that masturbation or partnered sex to relieve horniness is like drinking to relieve thirst, the action moves you from an unsatisfying state to a satiated state. However, if you are sexually attracted to someone, neither masturbation nor having sex with that person will relieve that sexual attraction state, as unlike sexual desire states sexual attraction states have no object that will satisfy them. But sexual attraction will motivate us to pursue sex with the people we're attracted to, because the state is constituted by sexual desires for those people, rather than sexual desires to relieve horniness.

[vega57]

14 minutes ago, Pramana said:

The idea is that masturbation or partnered sex to relieve horniness is like drinking to relieve thirst, the action moves you from an unsatisfying state to a satiated state.

Those are not the only two choices that are available.  People can choose to do nothing.  Yes, that IS a valid option.  Is it easy?  No.  Is it doable?  Yes. 

 

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However, if you are sexually attracted to someone, neither masturbation nor having sex with that person will relieve that sexual attraction state

Then what WILL relieve that sexual attraction state?

 

 

[Pramana]

2 minutes ago, vega57 said:

Those are not the only two choices that are available.  People can choose to do nothing.  Yes, that IS a valid option.  Is it easy?  No.  Is it doable?  Yes. 

That's true. I was referring only to what you would need to do if you wanted to act on those desires. But you have the freedom to choose otherwise.

 

4 minutes ago, vega57 said:

Then what WILL relieve that sexual attraction state?

Nothing. That's the paradox. Sexual attraction states are analogous to states of aesthetic appreciation. It's like experiencing the beauty of a landscape or an artwork, there's no object to move from there to a better state (in contrast to hunger, where you want to eat so you're no longer hungry). So when people act on sexual desires related to sexual attraction states, they undertake the same sorts of activities as they would if they were acting on sexual desires related to sexual appetites, and thus while they might succeed in assuaging their sexual appetites, the attraction state persists. So what's the point? I gather that people generally receive more intrinsic goods from having sex with people they're attracted to than through sex with unattractive partners or through masturbation, though, because since sexual attraction is constituted by sexual desires for other people, we can't substitute with masturbation like we can when our sexual desires are solely to relieve horniness.

By the way, my reference for this idea: Richards, Bradley. “Sexual Desire and the Phenomenology of Attraction”, Dialogue 54:2 (2015): 263-283.

[vega57]

16 minutes ago, Pramana said:

Nothing. That's the paradox. Sexual attraction states are analogous to states of aesthetic appreciation.

Again I don't agree that there's "nothing" that can be done about it.  Picture a heterosexual man who sees a curvy woman from behind.  He notices her long auburn hair...shapely legs sporting a pair of high heels.  Smooth, tan skin.  He's already sexually attracted to her.  He casually walks around to see her face...and is horrified to discover that "she" has an Adam's apple.  Do you think he's still going to be sexually attracted to "her"? 

 

One little 'trick' I learned a long time ago is that if someone wants to stop being attracted to someone, they have to find something that's unattractive about them.  I've used this tactic myself, and even though I wasn't sexually attracted to someone, I did feel a sense of 'attraction' toward them...which I quelled by finding something about them that I didn't find appealing. 

 

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It's like experiencing the beauty of a landscape or an artwork, there's no object to move from there to a better state (in contrast to hunger, where you want to eat so you're no longer hungry).

I guess it depends on how we define a "better" state.  For me, I was in a "better" state because I was no longer distracted by my 'attraction' to someone.  I could focus on my studies, which was most important to me.   

 

[Pramana]

57 minutes ago, vega57 said:

Again I don't agree that there's "nothing" that can be done about it.  Picture a heterosexual man who sees a curvy woman from behind.  He notices her long auburn hair...shapely legs sporting a pair of high heels.  Smooth, tan skin.  He's already sexually attracted to her.  He casually walks around to see her face...and is horrified to discover that "she" has an Adam's apple.  Do you think he's still going to be sexually attracted to "her"? 

 

One little 'trick' I learned a long time ago is that if someone wants to stop being attracted to someone, they have to find something that's unattractive about them.  I've used this tactic myself, and even though I wasn't sexually attracted to someone, I did feel a sense of 'attraction' toward them...which I quelled by finding something about them that I didn't find appealing. 

 

I guess it depends on how we define a "better" state.  For me, I was in a "better" state because I was no longer distracted by my 'attraction' to someone.  I could focus on my studies, which was most important to me.   

Right, I would agree with that. I think the difference is between doing something intended to satisfy the sexual attraction state, versus ignoring it and letting it pass, or doing something like what you describe to make it pass quicker.

[causidicus]

How, if at all, does all of this relate to legal bans on sexual orientation conversion therapy?  New York City is enacting a ban impacting children and adults.  New York City is also amending its human rights law to include asexuality in its definition of sexual orientation.

[Pramana]

11 hours ago, causidicus said:

How, if at all, does all of this relate to legal bans on sexual orientation conversion therapy?  New York City is enacting a ban impacting children and adults.  New York City is also amending its human rights law to include asexuality in its definition of sexual orientation.

1. Previous American laws that have extended human rights protections to asexuality have either defined sexual orientation in terms of attraction, or they have left sexual orientation undefined (practically speaking, either approach results in relying on self-identification, since I can't imagine a court ordering tests to prove an individual's reported attractions). This law says that it is illegal to offer therapies intended to change a person's sexual orientation, or to change their gender identity to the one they were assigned at birth (thus relying on self-identification for identities).

2. HSDD is defined in the DSM-5 as low sexual desire that causes distress for people who do not self-identify as asexual (note that in psychology, asexuality is usually defined as a lack of sexual attraction, rather than sexual desire, but the DSM-5 diagnostic exclusion is based on self-identification).

3. However, some queer theorists argue that the definition of asexuality should be expanded to encompass low or absent sexual desire, where the individual still experiences sexual attraction.

4. Thus, people who ascribe to #3 could argue that #2 constitutes conversion therapy, in violation of #1.

I think the issue would be that people seeking the religiously motivated gay conversion therapies that the law targets self-identify as homosexual, whereas those seeking treatment for HSDD don't self-identify as asexual. The argument that HSDD critics would have to make is that for a percentage of those seeking treatment, the sources of distress are outside factors (pressure from partners, social expectations). I don't think that would be enough to bring it within the scope of the law, though, unless the person self-identifies as asexual, but if a person self-identifies as asexual then they wouldn't be treated for HSDD anyway (given that the diagnostic criteria for HSDD in the DSM-5 excludes low desire that is better explained by self-identification as asexual).

[causidicus]

On 12/6/2017 at 2:17 PM, Pramana said:

I think the issue would be that people seeking the religiously motivated gay conversion therapies that the law targets self-identify as homosexual, whereas those seeking treatment for HSDD don't self-identify as asexual....

Thanks for the reply.

 

My perception is that many (most? especially young people) who undergo conversion therapy do NOT self-identify as "homosexual" or any political label.  They are labelled (either by themselves or by others) as "confused" or experiencing "unwanted" desires and attractions.  Maybe the law must be broadly read to have any sort of effect since many conversion therapists, especially those seeking to adapt their message to changing societal understandings around sexual orientation and its apparent immutability, seem to grudgingly acknowledge that their therapies are aimed at managing (i.e., suppressing) rather than completely changing.  If this is in fact what is going on, there may be a case for including asexuals even if they do not (yet) identify as such.

[LeChat]

On ‎12‎/‎6‎/‎2017 at 2:17 PM, Pramana said:

...2. HSDD is defined in the DSM-5 as low sexual desire that causes distress for people who do not self-identify as asexual (note that in psychology, asexuality is usually defined as a lack of sexual attraction, rather than sexual desire, but the DSM-5 diagnostic exclusion is based on self-identification).

3. However, some queer theorists argue that the definition of asexuality should be expanded to encompass low or absent sexual desire, where the individual still experiences sexual attraction...

Yes. One reason why it's problematic if someone who previously experienced sexual attraction towards others, suddenly lost their sexual desire, is that it could be due to an undiagnosed medical illness (e.g., cancer); if those who have HSDD are told they should just identify as asexual and not worry about it, without being checked out by a doctor, their possible, undiagnosed medical issue might shorten their lives, than if they'd gotten medical help when they realized their sexual desire declined. 

[Pramana]

24 minutes ago, causidicus said:

Thanks for the reply.

 

My perception is that many (most? especially young people) who undergo conversion therapy do NOT self-identify as "homosexual" or any political label.  They are labelled (either by themselves or by others) as "confused" or experiencing "unwanted" desires and attractions.  Maybe the law must be broadly read to have any sort of effect since many conversion therapists, especially those seeking to adapt their message to changing societal understandings around sexual orientation and its apparent immutability, seem to grudgingly acknowledge that their therapies are aimed at managing (i.e., suppressing) rather than completely changing.  If this is in fact what is going on, there may be a case for including asexuals even if they do not (yet) identify as such.

Very interesting, I don't know much about conversion therapy services, but I had been wondering about how this law would be enforced. If the issue will be people saying "we're not trying to change a sexual orientation, we're trying to change this other thing, which is a problem", then like you describe that creates a parallel with the situation between asexuality and HSDD. An issue with the current DSM-5 criteria is that while self-identification as asexual is excluded, there is no requirement to provide information about asexuality to those who may be unaware of it. I think that would be the place for advocates to focus.

[Pramana]

1 minute ago, InquisitivePhilosopher said:

Yes. One reason why it's problematic if someone who previously experienced sexual attraction towards others, suddenly lost their sexual desire, is that it could be due to an undiagnosed medical illness (e.g., cancer); if those who have HSDD are told they should just identify as asexual and not worry about it, without being checked out by a doctor, their possible, undiagnosed medical issue might shorten their lives, than if they'd gotten medical help when they realized their sexual desire declined. 

Queer theorists are primarily motivated by a desire to challenge the patriarchy and compulsory sexuality (so they see it as a problem where a woman would be fine without having sex, but for the fact that her husband wants more sex). There's a question about how important these considerations are to people who aren't really ideological about the issue. Should doctors be required to provide patients with information about the different political interpretations?