Expert: ‘Biology Plays a Really Important Role in Sexual Health’ for Women, Men

Pharmacy Times interviewed Rachel Rubin, MD, an assistant clinical professor in urology at Georgetown University, a urologic surgeon who specializes in the treatment of sexual dysfunction in both men and women, and one of only a handful of physicians trained in both female and male sexual medicine, on hypoactive sexual desire disorder (HSDD) and the current treatments available for this medical condition.

Alana Hippensteele: What is hypo sexual desire disorder, and how many women and men does it affect?

Rachel Rubin: Thank you so much for having me—it is really such an honor to be here. One clarification—it's hypoactive sexual desire disorder. It's just fancy doctor terminology for low libido and when you are bothered by low libido.

So, low libido is really not a medical condition if you are not bothered by it, but if you say, ‘Oh my goodness, I used to really want intimacy and sexual activity, and now I just don't want it anymore, but I want to want it,’ or if you say to yourself, ‘Gosh, my partner used to initiate and I used to respond and really like to be with my partner, and now I just don't want that at all anymore, and that bothers me’—that is a medical condition.

If it doesn't bother you, there's no reason to see a doctor, but it bothers a lot of people. So, interestingly enough, when you look at the data, especially in women, about 40% of women have what we would classify as low libido, but only about 10% are bothered by it, making only about 10% with that HSDD diagnosis.

Alana Hippensteele: That is really interesting. Is HSDD always associated with psychological and/or emotional components, or can it be a purely physical disorder separate from psychological or emotional complications?

Rachel Rubin: That is such a great question, and I don't know about you, but I can't take my brain outside of my biology; I can't remove it. So, I am my psychosocial upbringing, I am my psychology, it’s a part of biology.

I think the idea is that we are all biopsychosocial beings and biology plays a really important role in sexual health and especially in HSDD. There are lots of patients that I have who come to see me and say, ‘Hey, Dr. Rubin, I love my partner. We have so much fun together, and we are great parents together. We enjoy each other. There's nothing wrong in our relationship, I'm not depressed, I'm not anxious, I have no medical problems, I just don't want sex anymore. But I really used to want it, and I really miss that I used to want it, and can we do something about it.’ In those situations, we do have biological solutions that can potentially help in those situations.

Alana Hippensteele: For those who experience a psychological and/or emotional comorbidity with HSDD, what are the conditions that are commonly associated with it?

Rachel Rubin: So, anything that affects your brain and mental health can affect your sexual function—sexual health is just health. So, why I love my job so much is because I can work with people and really break down what's going on in their physical health and their mental health, and how that may be affecting their plumbing and how it might be affecting how they're performing as a partner.

So, my knowledge of biology is really helpful because I can understand how certain medications or surgeries can affect sexual health. So, anything can affect your sexual health—the death of a family member, a trauma history, depression, anxiety, or PTSD.

So, think about if you're running from, say, a tiger. Do you want to have an erection at that moment, or do you want to have an orgasm in that moment? No. You're going to get eaten. So, we're not supposed to be sexual beings at every moment of the day, and so really, it's understanding what is happening in your life from a biopsychosocial perspective and how that could be affecting sexual health.