Decreased Sexual Desire Screener

Abstract

The Decreased Sexual Desire Screener (DSDS) is a concise, patient-reported diagnostic instrument developed to aid clinicians in identifying generalized acquired Hypoactive Sexual Desire Disorder (HSDD) in women across various life stages, including premenopausal, perimenopausal, and postmenopausal populations. The DSDS is specifically validated for use by general practitioners and clinicians who lack specialized training in the diagnosis of Female Sexual Dysfunction (FSD). The instrument utilizes a combination of four direct Yes/No screening questions concerning desire decrease and associated distress, along with a fifth, multi-part question designed to assist in the critical process of differential diagnosis, aligning its criteria with the guidelines set forth in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR).

Keywords

Decreased Sexual Desire Screener, DSDS, Hypoactive Sexual Desire Disorder (HSDD), Female Sexual Dysfunction (FSD), Sexual desire, Screening instrument, Flibanserin, Women’s health, Sexual medicine, Diagnostic screening.

Authors

Anita H. Clayton, Evan R. Goldfischer, Irwin Goldstein, Leonard R. Derogatis, Diane J. Lewis-D’Agostino, Robert Pyke.

Purpose

The primary purpose of the DSDS is to serve as a fast and reliable diagnostic aid for non-specialist clinicians seeking to establish a diagnosis of generalized acquired Hypoactive Sexual Desire Disorder (HSDD). It is designed to quickly screen whether a woman meets the core criteria for this specific diagnosis, which requires evidence of decreased desire that causes personal distress and is acquired (not lifelong).

The DSDS facilitates differential diagnosis by including a section (Question 5) that addresses potential comorbid or causative factors, such as medical conditions, medication use, relationship dissatisfaction, or other sexual issues (e.g., Female Sexual Arousal Disorder [FSAD] or Female Orgasmic Disorder [FOD]). While it assists in differential diagnosis, it is explicitly stated that the DSDS is not intended to diagnose or exclude other forms of FSD, which may occur concurrently with HSDD.

Construct

The DSDS measures the core components of generalized acquired Hypoactive Sexual Desire Disorder (HSDD) as characterized by the DSM-IV-TR. This construct is defined by three essential elements:

• Acquired Deficiency: A significant decrease in sexual desire or interest compared to a previously satisfying baseline level (Questions 1 and 2).

• Personal Distress: The reduced desire causes marked distress or interpersonal difficulty for the patient (Question 3).

• Desire for Change: The patient explicitly wishes for her level of sexual desire or interest to increase (Question 4).

The final component (Question 5) is crucial for the construct, ensuring that the diagnosis is not better explained by co-occurring psychiatric, medical, substance-related, or relational factors, thereby confirming the generalized acquired nature of the HSDD.

Validity

The validity of the DSDS was established through multiple studies, including a non-treatment validation study (Clayton et al., 2009) and screening periods within two major Phase III trials for the drug flibanserin (ROSE and ORCHID studies).

• Nontreatment Validation Study (North America): This study involved 263 women (aged 18 to 50) with and without FSD. DSDS results, obtained by non-expert clinicians, were compared against diagnoses made by expert FSD clinicians using extensive interviews. The DSDS demonstrated strong performance, yielding a sensitivity of .836 and a specificity of .878 for identifying generalized acquired HSDD.

• ROSE Study (North America): Screening 921 premenopausal women (aged ≥18) with decreased sexual desire showed high diagnostic accuracy, with the DSDS achieving a sensitivity of .946. Specificity was not calculated due to the pre-selected clinical population complaining of low desire.

• ORCHID Study (Europe): In a sample of 513 premenopausal European women (aged ≥18), the DSDS maintained excellent cross-cultural diagnostic utility, reporting a sensitivity of .956.

• Clinical Utility: Debriefing exercises showed that 85.4% of participants understood all five questions. Furthermore, non-expert clinicians reported that they could reliably use the DSDS to rule in or rule out HSDD in 93% of the cases reviewed.

Reliability

While traditional internal consistency measures (like Cronbach’s alpha) are not explicitly detailed in the source material, the validation studies strongly imply high reliability, particularly in terms of inter-rater agreement and clinical utility. The DSDS demonstrated that non-expert clinicians could achieve results highly consistent with those of expert FSD clinicians (as evidenced by the high sensitivity and specificity figures), indicating that the instrument provides a reliable and standardized method for identifying generalized acquired HSDD based on patient self-report and subsequent clinical review.

Factor Analysis

The source content does not provide information regarding a formal factor analysis of the DSDS structure. However, the instrument is conceptually structured around two key dimensions required for an HSDD diagnosis: the existence of the symptom (decreased desire and distress, Questions 1-4) and the exclusion of confounding variables (differential diagnosis, Question 5). The high validation statistics suggest that these items function effectively as a single, cohesive screening mechanism for the target construct.

Instrument

Test Type: Brief diagnostic screener/Patient-reported outcome measure (with mandatory clinician review).

Format: Five questions in total: four Yes/No questions and one seven-part checklist for differential diagnosis.

Language Available: English (validated in North America) and European languages (validated in the ORCHID trial).

Population Group: Women.

Age Group: Adults (Aged ≥18 years, including women 18 to 50 years in validation studies).

Population Details: Pre-, peri- and postmenopausal women who report decreased sexual desire. Participants in validation studies were required to be in a stable, communicative, monogamous heterosexual relationship with a sexually functional partner for at least one year.

Test Methodology: Patient self-administration followed by a mandatory clinician review to verify answers and make a final diagnostic determination based on the DSDS results and DSM-IV-TR criteria.

Keywords

Psychological assessment, Sexual health questionnaire, Clinical screening tool, Diagnostic criteria, HSDD diagnosis, Flibanserin trials, ROSE study, ORCHID study.

Authors

Author ORCID Identifier: Not provided in source content.

Affiliation Email addresses: Not provided in source content.

Correspondence Address: Anita Clayton, University of Virginia Health System, Department of Psychiatric Medicine, 2955 Ivy Road, Northridge Suite 210, Charlottesville, VA 22903; e-mail: [email protected]

Permissions & Fee and Test Year

The DSDS instrument is copyrighted by Boehringer Ingelheim International GmbH (2005). All rights are reserved. Any commercial use or reproduction of this questionnaire without explicit written authorization from the copyright holder is strictly prohibited.

The primary validation studies and initial publications occurred between 2008 and 2009.

Reference’s

• American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

• Clayton, A. H., Goldfischer, E. R., Goldstein, I., Derogatis, L., Lewis-D’Agostino, D. J., & Pyke, R. (2009) Validation of the Decreased Sexual Desire Screener (DSDS): A brief diagnostic instrument for generalized acquired female Hypoactive Sexual Desire Disorder (HSDD). Journal of Sexual Medicine, 6, 730–738.

• Goldfischer, E. R., Clayton, A. H., Goldstein, I., Lewis-D’Agostino, D. J., & Pyke, R. (2008). Decreased Sexual Desire Screener© (DSDS©) for diagnosis of Hypoactive Sexual Desire Disorder in women. Obstetrics and Gynecology, 111, 109S.

• Nappi, R., Dean, J., Hebert, A., & Pyke, R. (2008, December). Decreased Sexual Desire Screener (DSDS) for diagnosis of Hypoactive Sexual Desire Disorder (HSDD) in European women. Poster presented at the Joint Congress of the European and International Societies for Sexual Medicine, Brussels, Belgium.

Items of the Decreased Sexual Desire Screener

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

1. In the past, was your level of sexual desire or interest good and satisfying to you?

2. Has there been a decrease in your level of sexual desire or interest?

3. Are you bothered by your decreased level of sexual desire or interest?

4. Would you like your level of sexual desire or interest to increase?

5. Please check all the factors that you feel may be contributing to your current decrease in sexual desire or interest:

   A. An operation, depression, injuries, or other medical condition

   B. Medications, drugs or alcohol you are currently taking

   C. Pregnancy, recent childbirth, menopausal symptoms

   D. Other sexual issues you may be having (pain, decreased arousal or orgasm)

   E. Your partner’s sexual problems

   F. Dissatisfaction with your relationship or partner

   G. Stress or fatigue