#hsdd

guys is this too specific? 😋

I get that you probably mean because a lot of people still don't know what asexuality is, which is fair. We do need more education around that and more visibility for it. But it's still classified as a disease or disorder for people who aren't ace because for people who aren't ace it's a symptom of several medical conditions and medication side effects. If you're ace you're ace, but if you're not ace then sexual dysfunction of any kind can be very distressing and addressing what is causing it is important in those cases.

Ok, thank you for bringing this up because I want to talk about it. (This ask refers to this post, for anyone who only sees this.)

I only touched on this very briefly originally, and someone who hasn’t spent way too much time researching asexuality and how the world regards it (aka me) might see this as an overstatement. I promise it’s not.

My main point here is that most people who diagnose HSDD (hypoactive sexual desire disorder) will do that and not even suggest that someone consider the possibility they’re asexual. You have to know you’re ace and have the confidence to assert that to a (potentially quite dubious) medical professional in order to not be diagnosed with HSDD. It sets an alarming precedent that the disorder is the default, and asexuality is the exception. You’re right, we do need more education and visibility around asexuality. We also don’t need HSDD.

I know this isn’t your main point, but I wanted to bring it up anyway: being distressed about being ace doesn’t mean you aren’t ace. Most ace people are, at some point. It’s not necessarily an easy thing to come to terms with. We think something’s wrong with us because the whole world is telling us that it’s not normal to not be sexually attracted to people, and diagnoses like HSDD only perpetuate that assumption. It also creates this conception that it’s treatable, or curable. It’s not. It’s a sexuality, like heterosexuality, like homosexuality, whatever. No medication can ‘cure’ your sexuality, and largely, people have come to accept that, as long as an individual has some sexual desire of some kind. With asexuality, the assumption is normally that someone is ace because they are broken somehow, and they need to be fixed.

The diagnostic criteria for Female Sexual Interest/Arousal Disorder and (Male) Hypoactive Sexual Desire Disorder respectively at present according to the DSM are as follows (taken from here):

(They used to both be HSDD but they split them up into ‘female’ and ‘male’ versions, for reasons I’m not sure I comprehend. I’m not going to get into that here, but the only thing that’s really important right now is that it’s the same disorder.)

Note part D: “The sexual dysfunction is not better explained by a nonsexual mental disorder […] and is not attributable to the effects of a substance/medication or another medical condition.” Part of the criteria for FSID/HSDD is that it can’t be attributed to something else.

If you’re on a medication or have a medical condition that means you have low sexual desire, you shouldn’t be diagnosed with FSID/HSDD. It is purely for people who do not experience sexual desire and don’t know why.

So, there’s a person who doesn’t experience sexual desire. Nothing caused it. Are they asexual, or are they disordered? The APA would say that it’s the latter. So would the WHO. Maybe they’re aware of asexuality, maybe they’re not. If they don’t personally identify that way, according to current medical advice, they should be diagnosed with a disorder which doesn’t have a cure or any effective treatment, and not perhaps suggested to that they may be asexual so that they can take solace in a community that knows what it’s like and knows they’re not broken.

HSDD does not exist to get treatment for people who are experiencing distressing side effects to medical treatment or conditions. If it did, then yeah, I’d concede that it has its place. What it does do is alienate asexual people who don’t know that’s what they are by telling them there’s something wrong with them and it needs treating. It tells ace people who know that’s what they are that in most medical settings, they’re unlikely to find a professional who agrees with them. It’s institutional acephobia at its finest, and it should not be regarded as a valid diagnosis.

I've been looking into the work to remove homosexuality from the DSM and examining how that can inform asexual work around HSDD (Hypoactive Sexual Desire Disorder). Much of the push to remove homosexuality worked to legitimize gayness while also legitimizing the category of mental disorder and the authority of the American Psychological Association (APA). This is almost exactly what's happening with asexuality and HSDD. Much of the writing around it, specifically Dr. Brotto's, works to distinguish asexuality from "real" disorder. It positions asexuality as a valid sexual orientation completely distinct from sexual disorders. In some ways this argument worked to get homosexuality out of the DSM, but it did so by trodding on the disabled, mad, ill, sexually deviant, gender non-conforming, political radicals and more. In the third edition of the DSM homosexuality was removed as a disorder. But, this edition also introduced a long list of paraphilias and a section on gender identity disorders. This edition is also credited with making the DSM the bible of mental disorders. The push to remove homosexuality also served to position the DSM and the APA as rational apolitical authorities.

If we wish to avoid the this, asexual critiques need to expand beyond HSDD to critique the very idea of mental disorder and the authority that upholds it. Asexuals, rather than distancing ourselves from illness and disability, must move closer to those communities. We must work in solidarity with these groups and embrace rather than eschew our commonalities.

(Link to the post mentioned)

The ads also make me uneasy. 

Long story short for some more context, HSDD isn’t even in the DSM-V (latest psychiatric diagnostic manual), and the updated related diagnoses have exceptions for if a person self-identifies as asexual while HSDD does not. (But what if a person hasn’t heard of asexuality but would otherwise self identify as such? And since the drug is approved to treat HSDD not the newer FSAID, does that even matter?)

Also the drug doesn’t even work as it’s marketed, so whoops?

Imo, its existence is basically pathologizing low/no sexual desire (especially in women) and if that is seen as a problem that needs medicated, and if asexuality isn’t very widely known, its very easy for this all to make an unnecessary mess. It’s very compulsory sexuality, it’s very amatonormative, and it’s very pisses me off.

Somewhat luckily, flibanserin was originally approved in 2015 and was kind of a flop. Still, the ads I was seeing were concerning because of the same reasons different drug(?). There is some conversation in the notes of the post linked above and I will also link some older posts about flibanserin if anyone is interested in reading more.