Low libido is one of the most common sexual health concerns women experience, and also one of the most misunderstood.
If your interest in sex isn't what it used to be, it can be tempting to assume that something is wrong with your hormones, that you need more testosterone, or that you've simply "lost" your sex drive.
In reality, sexual desire is much more complex.
Hormones can absolutely play a role, particularly during perimenopause and menopause. But desire is influenced by a combination of hormones, physical health, medications, stress, sleep, relationships, mental health, sexual context and the way your brain responds to sexual cues.
Understanding why your libido has changed is therefore much more useful than simply trying to "boost" it.
What is libido?
Libido is another term for sexual desire or interest in sexual activity.
But one of the biggest misconceptions about libido is that sexual desire should simply appear spontaneously. You might expect to suddenly think: "I want to have sex."
For some people, that happens frequently. For others, it doesn't, and that doesn't necessarily mean their libido is abnormal.
Research into female sexual response has shown that desire can be both spontaneous and responsive.
Spontaneous desire occurs when sexual interest seems to appear on its own. Responsive desire develops after something has started to create sexual interest or arousal, such as affection, touch, emotional connection or sexual stimulation.
This distinction can become particularly important in long-term relationships and during different stages of life.
Some women who believe they've "lost their libido" may actually still experience desire. It simply doesn't begin the way they expect it to.
What causes low libido in women?
There usually isn't one single cause.
Women's sexual desire is often described using a biopsychosocial model, meaning biological, psychological and social or relationship factors can all influence it.
Here are some of the most common contributors.
1. Hormonal changes
Sex hormones interact with the brain, genital tissues and sexual response, which means hormonal changes can affect desire in some women.
This can become particularly noticeable during perimenopause and menopause. Estrogen levels become more variable during perimenopause and eventually decline after menopause. Testosterone also gradually changes across adulthood.
But hormones don't exist in isolation. Two women with similar hormone levels can have completely different experiences of sexual desire. That's why checking a testosterone level alone rarely explains the entire picture.
2. Vaginal dryness or painful sex
It's difficult for the brain to become excited about something it has learned may be uncomfortable.
Declining estrogen around menopause can contribute to changes in vaginal and vulvar tissues, including dryness, irritation and discomfort during sex. When sex becomes uncomfortable, women may naturally become less interested in initiating it.
Sometimes what appears to be a desire problem is therefore partly a pain or arousal problem. Addressing discomfort can be an important part of addressing libido.
3. Stress and mental load
Sexual desire requires more than functioning hormones. Your brain also needs enough capacity to notice and respond to sexual cues.
Chronic stress, work demands, caregiving, parenting and the constant mental load of daily life can make that much more difficult. You may love your partner and still find that sex is nowhere near the top of your brain's priority list after a demanding day.
That doesn't necessarily mean there is something wrong with your relationship or with you. It may mean that the conditions that previously allowed desire to emerge have changed.
4. Sleep and fatigue
Being exhausted isn't particularly compatible with sexual interest.
Poor sleep can influence mood, energy, stress regulation and overall wellbeing, all of which can indirectly affect sexual desire. This can become especially relevant during perimenopause, when night sweats, insomnia and changing sleep patterns may appear at the same time as changes in libido.
5. Medications
Certain medications can affect sexual desire, arousal or orgasm. One of the most commonly discussed examples is antidepressant medication, particularly selective serotonin reuptake inhibitors (SSRIs).
Other medications and medical conditions can also affect sexual function. If you notice a significant change in libido after starting or changing a medication, it's worth discussing with your healthcare provider rather than stopping the medication on your own.
6. Relationship and sexual context
Libido doesn't exist independently from the sexual experience itself. Relationship satisfaction, emotional connection, communication, conflict, attraction, novelty and the type of sexual stimulation you're receiving can all influence desire.
One useful question isn't simply: "Why don't I want sex?" It may be: "Is the sex I'm being offered something my brain and body actually want?" That's a very different question.
7. Mental health
Depression and anxiety can both affect sexual desire. So can body-image concerns, past sexual experiences, trauma, performance anxiety and negative beliefs surrounding sexuality.
This doesn't mean low libido is "all in your head." It means that sexual desire involves the brain as much as it involves the reproductive system.
Is low libido always a medical problem?
No.
There is a wide range of normal sexual desire, and libido can change throughout life. A lower level of desire becomes more clinically relevant when the change is persistent and causes personal distress.
Hypoactive Sexual Desire Disorder, or HSDD, is a recognized sexual health condition involving persistently reduced or absent sexual desire that causes significant distress.
Importantly, having less desire than your partner does not automatically mean you have HSDD. Neither does having less spontaneous desire than you had when you were younger. The context matters.
What about testosterone?
Testosterone is involved in female sexual function, but the relationship between testosterone levels and libido isn't as simple as "low testosterone = low libido."
A blood testosterone level alone cannot diagnose the cause of low sexual desire.
There is evidence supporting testosterone therapy for appropriately selected postmenopausal women with HSDD, after other contributing factors have been evaluated. That is very different from saying that every woman experiencing low libido needs testosterone.
A comprehensive assessment should consider the full picture first.
What can you do if your libido has changed?
Instead of immediately looking for something to "boost" your sex drive, start by asking what may have changed.
Consider:
- Has sex become uncomfortable?
- Are you experiencing perimenopause or menopause symptoms?
- Did your libido change after starting a medication?
- Are you chronically stressed or exhausted?
- Do you experience desire once sexual activity has already started?
- Has your relationship or sexual routine changed?
- Are you getting the type of stimulation you actually enjoy?
- Is the change in libido bothering you, or mainly someone else?
The answers can point toward very different solutions.
The bottom line
Low libido in women rarely comes down to one hormone.
Sexual desire is influenced by the brain, hormones, physical comfort, medications, stress, sleep, relationships, mental health and sexual context.
And sometimes what feels like "losing your libido" is actually a change from spontaneous desire to more responsive desire.
Understanding the difference and identifying the factors affecting your sexual response is often much more useful than searching for a supplement or hormone that promises to increase sex drive.
Want to understand your libido more deeply?
Our Low Libido & Sexual Health in Perimenopause & Beyond course takes a deeper look at how sexual desire actually works, why it can change during perimenopause and menopause, and the hormonal, physical, psychological and relationship factors that can influence it.
Explore the Low Libido & Sexual Health Course →
References
Basson R. The female sexual response: a different model. Journal of Sex & Marital Therapy. 2000;26(1):51–65.
Goldstein I, Kim NN, Clayton AH, et al. Hypoactive Sexual Desire Disorder: International Society for the Study of Women's Sexual Health Expert Consensus Panel Review. Mayo Clinic Proceedings. 2017;92(1):114–128.
Parish SJ, Simon JA, Davis SR, et al. International Society for the Study of Women's Sexual Health Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women. Journal of Sexual Medicine. 2021;18(5):849–867.