The Decreased Sexual Desire Screener in practice

What it is

The Decreased Sexual Desire Screener (DSDS) was built for exactly your situation: a clinician who is neither trained nor specialised in female sexual dysfunction, with no time for a forty-minute interview. In its validation study of 263 women across 27 centres, diagnosis by DSDS with a non-expert clinician agreed with an expert diagnostic interview in 85.2% of cases — sensitivity 83.6%, specificity 87.8% (Clayton et al., 2009). Non-expert clinicians judged the questions adequate to reach a diagnosis in 93% of cases.

The five questions

The patient answers the first four yes/no:

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?

Question 5 asks her to tick any factors she believes contribute, from a list that covers: an operation, depression, injuries or other medical conditions; medications, drugs or alcohol; pregnancy, recent childbirth or menopausal symptoms; other sexual issues (pain, arousal or orgasm); her partner's sexual problems; dissatisfaction with the relationship or partner; stress or fatigue.

Scoring

Yes to all of questions 1–4, and the clinician's review of question 5 finds none of the listed factors sufficient to explain the loss of desire → consistent with generalised acquired HSDD.

Any "no" in 1–4 → not HSDD by this instrument. A "no" to question 1 points towards lifelong low desire; a "no" to 3 means no distress, and therefore no disorder.

A "yes" to any factor in question 5 does not exclude HSDD — it tells you what to assess first. This is the bridge into the biopsychosocial screen on the next page.

What it doesn't do

It doesn't measure severity, it doesn't replace the conversation, and it is validated for diagnosis of generalised acquired HSDD specifically — not for situational low desire, arousal disorder, or pain. Use it as a structured start, not a verdict.

Using it in ten minutes

Hand it over on paper or on a tablet while you finish the previous task. Read the answers together. If 1–4 are all yes, spend the remaining minutes on question 5 — that's where the clinical judgement lives. Referral criteria are on the "When to refer" page.

Reflective learning

1. Which of the question-5 factors would you feel confident managing yourself, and which would prompt referral?
2. How would you introduce the screener so it feels like care, not a form?
3. A patient answers yes to 1–4 and ticks "stress or fatigue". What is your next question?

References

• Clayton AH, Goldfischer ER, Goldstein I, et al. Validation of the Decreased Sexual Desire Screener (DSDS). J Sex Med 2009;6:730–8. doi:10.1111/j.1743-6109.2008.01153.x