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However, they have also been described on the face, neck, lower trunk, extremities, and buttocks ( Fig

68 Physiologic factors Physical health Neurotransmitter effects Endocrine function Illness Psychological factors Performance anxiety Depression Sociological factors Upbringing Cultural norms/expectations Contextual factors Insufficient privacy Safety Emotional support Lack of appropriate stimuli Inadequate physical stimulation Partner dysfunction Interpersonal factors Relationship discord Lack of emotional intimacy Interpersonal development history Sexual, physical, or medical trauma Distressful emotions: fear, shame, guilt Expectation of an adverse outcome Having a history of disappointing sex The etiology of HSDD can be thought of as an imbalance between excitatory factors and inhibitory factors

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