Read (1995) indicates a number of possible sources of HSDD including the experience of sexual trauma such as assault or rape. Bereavement, infertility, sudden loss of a job, giving birth and undergoing surgery are some of the other potential causes that she highlights. Walsh and Berman (2004) believe that as much as 60% of the causes of sexual dysfunction are naturally occurring or organic (p. 661). This therefore suggests that imbalances or changes in hormonal levels, reactions to medication or experiencing depressive conditions may be at the root of HSDD most of the time.
Nappi, Wawra & Schmitt (2006) add that it is important to consider these factors first in any attempts at diagnosis and evaluation but other external factors such as problems in an intimate relationship should be examined equally as often (p. 320). This as each individual is differentially affected by any of the possible causal factors and a complete analysis must be done which considers all possibilities. Among the most noted correlates of the development of HSDD in women are hormonal, surgical, psychological, physiological or other individual factors.
The balance of hormones in the female body is felt to be an important consideration in examining the development of HSDD. Hormones have been noted to play a very important role in proper sexual functioning (Nappi, Wawra & Schmidt, 2006, p. 319). Estrogens and androgens in particular are said to be responsible for regulating and controlling sexual stimulus by communicating to the brain those sensations that are perceived as sexual.
These hormones are also felt to be responsible for the level of sensitivity of the genitals and other sexually associated organs. Nappi, Wawra & Schmidt (2006) note that the function of hormones in this regard are to “elicit conscious perception and pleasurable reactions by influencing the release of specific neurotransmitters and neuromodulators” (p. 319). This point demonstrates the importance of hormones in linking received stimulus to the brain and transferring the brain’s response to the respective sexual organs.
Warnock, Bundren and Morris (1997) also emphasize the importance of hormones in proper sexual functioning noting that female libido is significantly controlled and therefore affected by testosterone (p. 761). In a later research these same researchers highlight that testosterone is the hormone which is mainly responsible for sexual desire in women (Warnock, Bundren & Morris, 1999, p. 176). Given the importance of hormones in influencing female sexual desire it is evident that reductions or abnormalities in the body’s production of these naturally occurring hormones may lead to sexual complications.
Warnock, Bundren and Morris (1997) indicate that, a deficiency in testosterone, in particular, results in a decrease or loss of sexual desire (p. 761). Of course determining the causes of the changes in hormonal levels is another issue. Other physiological or external factors may be responsible for this occurrence such as the onset of menopause. Surgical and physiological factors Female surgical procedures may compromise the body’s ability to properly regulate hormones and to respond adequately to sexual stimuli.
Having either a hysterectomy (a surgical operation to remove the womb) or an oophorectomy (surgical operation to remove the ovaries) may result in changes in the body’s natural ability to produce sexually associated hormones and therefore lead to sexual dysfunction. Warnock, Bundren and Morris (1999) cite research indicating that a third of women in the U. S. have a hysterectomy by age 60 (p. 175). Further these procedures may also include the removal of the ovaries. One research estimates that 45% of hysterectomies performed in 1990 also involved the removal of the ovaries.
Hysterectomies and oophorectomies result in the cessation of the menstrual cycle for women who had not yet reached menopause. The onset of menopause usually carries with it reductions in the estrogen and testosterone produced by the body since the ovaries are primarily responsible for producing the androgens responsible for sexual desire and arousal. Warnock, Bundren and Morris (1997) indicate that androgen production is affected by as much as 50% following menopause and this is even further complicated when menopause is surgically induced (p. 761).