Premature (Early) Ejaculation 443
ence of desire across men and women, and the fact that desire fluctuates over time and is
dependent on contextual factors, men do repo rt a significantly higher intensity and fre-
quency of sexual desire compared with women.
Differential Diagnosis
Nonsexual mental disorders. Nonsexual mental disorders,  such as major depressive
disorder, which is characterized by “markedly dimi nished interest or pleasure in all, or al-
most all, activities,” may explai n the lack of sexual desire. If  the lack of desire is better
explained by another mental disorder, then a diagnosis of male hypoactive sexual desire
disorder would not be made. 
Substance/medication use. Substance/medication use may explain the lack of sexual
desire.
Another medical condition. If the low/absent desire and de ficient/absent erotic thoughts
or fantasies are better explained by the effect s of another medical co ndition (e.g., hypogo-
nadism, diabetes mellitus, thyroid dysfunction, central nervous system disease), then a di-
agnosis of male hypoactive sexual desire disorder w ould not be made. 
Interpersonal factors. If interpersonal or significant co ntextual factors, such as severe
relationship distress or other sig nificant stressors, are associated with the loss of desire in
the man, then a diagnosis of male hypoactive sexual desire disorder would not be made.
Other sexual dysfunctions. The presence of another sexual dysfunction does not rule out a
diagnosis of male hypoactive sexu al desire disorder; there is some evidence that up to one-half
of men with low sexual desire also have erecti le difficulties, and slightly fewer may also have
early ejaculation difficulties. If the man’s low desire is explained by self-identification as an