When to refer — and what happens next

Refer when

• Low or absent sexual desire that is persistent — six months or more — and causes her distress.
• Generalised (across contexts and partners) and acquired (she used to want sex).
• The biopsychosocial screen has found no sufficient explanation, or found contributors that have been addressed without recovery of desire.
• She is 18 or over and wants to explore options.

Manage or address first

• Active, untreated depression or anxiety — treat, then re-assess.
• A medication change within the last three months — review timing and options first.
• Dyspareunia, vaginal dryness or pelvic pain — treat the pain first.
• Undiagnosed thyroid disease, hyperprolactinaemia or significant iron deficiency.
• Pregnancy or breastfeeding.
• Situational low desire, or a relationship in acute difficulty — couples or psychosexual therapy is the right referral.
• Any concern about coercion or abuse — safeguarding pathway.

None of these bars a later referral; they are the sequence, not a gate.

What your patient receives

1. Contact from the clinic within two working days of your referral to arrange her consultation.
2. A structured consultation with a GMC-registered clinician: history, the DSDS, a biopsychosocial assessment against the ISSWSH process of care, and a discussion of every relevant route — psychosexual therapy, hormonal management, and other pharmacological options where a clinician judges them appropriate.
3. An individualised plan. If the assessment concludes this is not HSDD, she is told so, and you are told why.
4. Follow-up as clinically indicated.

The clinic never sells treatment, and no product is advertised or offered on this site. Any prescribing decision is independent, made by the clinician who saw her, and documented.

What you receive

A letter within five working days of the consultation covering impression, assessment performed, management plan in general terms, and follow-up arrangements. Anything prescribed is recorded for her notes so your record is complete. If further tests or shared care would help, the letter says so.

What we need from you

• Your name, role and GMC / NMC / GPhC number.
• Her name, date of birth and contact details, with her consent for us to contact her.
• One paragraph: what you have found and excluded, current medication, and anything you would like us to consider.

Refer a patient

Refer a patient →

Referral information is health data. It is handled under UK GDPR Article 9(2)(h) as part of the provision of care, stored in the clinic's clinical record system, and used for no other purpose. Our privacy notice sets out the detail.

Reflective learning

1. Which of your patients in the last year met the "refer when" criteria, and what happened to them?
2. What would make a letter back from a specialist service most useful to you?
3. Where is the boundary between what you manage and what you refer — and has it moved after reading this pathway?