In patients whose hypoactive sexual desire disorder is global, deficiency of sexual drive should be considered early in the assessment process, because an easily treatable condition, such as reduced serum testosterone, might be identified. Although assessment of sexual drive is difficult, answers to the following questions may help to ascertain whether the drive component is intact and, if so, its “strength”:

1. Do you have sexual thoughts (daydreams) that occur spontaneously without being triggered by seeing or hearing something sexually arousing? If so, how frequently do you have such thoughts?
2. Are you able to generate sexual fantasies or thoughts? If so, how frequently do you experience such fantasies?
3. Do you ever feel in need of sex? If so, how often?
If the patient answers positively to this question, the clinician must probe further to ascertain whether the patient actually feels the need for sex or the need for intimacy. Asking the patient “what feelings do you get that tell you you need sex?” is often helpful in differentiating these two feelings. People who need sex to satisfy sexual drive usually describe genital feelings (see next question) or frequent sexual thoughts, whereas answers such as “feeling the need to be close to someone or to be held” point to need for intimacy rather than sex. Need for intimacy is probably not triggered by sexual drive.
4. Do you ever experience spontaneous feelings of sexual arousal without these being triggered by seeing or hearing something sexually arousing (e.g., in women, genital lubrication, genital warmth, clitoral tingling; in men, penile erection, tingling in penis, feeling of fullness in penis or pelvis)? If so, how often?

Absent or deficient sexual drive should be investigated from the biological perspective, looking for endocrine, central nervous system, and systemic diseases and pharmacological explanations for the problem. If the result of such investigation is negative, then detailed psychological and psychiatric evaluation should be undertaken.