(833) The Cultural Shaping of Desire: A Systematic Review of Sociocultural Factors in the Presentation and Treatment of Hypoactive Sexual Desire Disorder

Introduction Hypoactive Sexual Desire Disorder (HSDD) is a prevalent concern in sexual medicine and therapy. Current diagnostic frameworks and treatment protocols, largely developed within Western, educated, industrialized, rich, and democratic (WEIRD) contexts, often prioritize individual psychological and biological factors. This approach may overlook the profound influence of sociocultural norms, beliefs, and values on the expression of sexual desire, the distress associated with its absence, and help-seeking behaviors. Integrating perspectives from sexology and cross-cultural psychology is crucial for developing culturally competent mental health and sex therapy practices. Objective This systematic review aimed to synthesize existing evidence on how cultural factors-including religiosity, gender roles, sexual scripts, and filial piety-influence the clinical presentation, subjective distress, and treatment pathways for individuals presenting with HSDD. Methods A systematic search of three major electronic databases (PubMed, Web of Science, and Scopus) was conducted for articles published from January 2015 to September 2025. Search terms included combinations of "hypoactive sexual desire," "low libido," "culture," "religion," "gender roles," "cross-cultural comparison," and "sex therapy." Eligible studies were qualitative, quantitative, or mixed-methods reports that explicitly discussed cultural dimensions in relation to HSDD in adults. Studies focusing exclusively on biological etiologies (e.g., hormone levels) without cultural analysis were excluded. Data extraction and quality assessment were performed by two independent reviewers. Results Out of 2,158 identified records, 48 studies met the inclusion criteria. The synthesis revealed several key themes:1. Expression of Distress: In more collectivistic societies, distress from HSDD was frequently linked to inability to fulfill marital duties or produce heirs, whereas in individualistic cultures, distress centered on personal fulfillment and loss of intimacy. 2. Gender and Sexual Scripts: Rigid gender norms (e.g., female passivity, male initiation) significantly influenced whether individuals perceived their low desire as a problem and their willingness to disclose it to a partner or clinician. 3. Religious and Moral Frameworks: Religious beliefs often shaped the meaning attributed to low desire, ranging from a spiritual failing to a virtuous state, thereby directly impacting help-seeking pathways, with many preferring pastoral over psychological counseling initially. 4. Barriers to Treatment: Stigma, shame, and a lack of culturally congruent therapy models were identified as significant barriers to effective care across diverse cultural groups. Conclusions The presentation and experience of HSDD are deeply culturally embedded. A one-size-fits-all diagnostic and therapeutic approach is insufficient. Findings from this review strongly advocate for the integration of a cultural formulation in sex therapy assessments. Mental health professionals and sexologists must adopt culturally sensitive approaches that explore the meaning of sexuality and desire within the patient's specific cultural context. Future research should focus on developing and validating adaptive interventions that respect cultural values while effectively addressing the psychological distress associated with HSDD. Disclosure No