Improving conversations around HSDD in clinical practice

In this video, Melissa Moran, DO, a urology resident at Rutgers Robert Wood Johnson Medical School in New Brunswick, New Jersey, discusses findings and clinical implications of the the International Society for the Study of Women's Sexual Health Annual Meeting study, “Analysis of Off-Label Medication Prescriptions and Google Search Trends for Postmenopausal Female Hypoactive Sexual Desire Disorder (HSDD),” focusing on treatment gaps, informed consent, and multidisciplinary care.

The study highlighted that a substantial proportion of prescriptions for HSDD therapies were written for women over age fifty, despite historically limited FDA-approved options for peri- and postmenopausal patients. Moran noted an important recent development: expanded approval of flibanserin (Addyi) for women under age 65, representing progress toward addressing this unmet clinical need.

HSDD affects approximately 10% to 12% of women overall, with the highest prevalence—estimated between 15% and over 30%—occurring in women aged 45 to 64 years. Because this population is significantly affected, clinicians must become familiar with diagnosis and management while engaging in careful risk–benefit discussions. When considering off-label therapies such as bremelanotide (Vyleesi), physicians should clearly explain that studies have primarily involved premenopausal women. Although those trials demonstrated meaningful improvements in sexual desire and reduced distress, comparable data in peri- and postmenopausal populations remain limited. Patients should therefore understand that potential benefits are inferred rather than definitively proven. At the same time, available research indicates a favorable safety profile, with mostly mild, transient adverse effects such as nausea, flushing, headache, and injection-site reactions. Shared decision-making and thorough informed consent are essential when pursuing off-label treatment.

Moran also emphasized the overlap between HSDD and genitourinary syndrome of menopause, underscoring the importance of multidisciplinary management. Urologists, gynecologists, and menopause specialists all play valuable roles in identifying symptoms and initiating conversations about sexual health, which patients often hesitate to raise due to embarrassment or misconceptions about aging. Urologists, even when treating urinary complaints, should proactively address sexual function and coordinate care across specialties. Open communication, patient comfort, and comprehensive documentation ultimately support more effective, patient-centered management of menopausal sexual health concerns.