Introduction

Low libido is when a person has a low sex drive, meaning they have little to no interest in sex. This condition affects 1 in 5 of the male population and is even more common in women. Having a low libido may lead to unmet needs and feelings of undesirability, which could cause distress in relationships and ultimately result in conflict.¹

Therapy is a form of treatment that is beneficial for many conditions, including physical and mental health issues. Since low libido is primarily associated with a person’s behaviour towards sex, therapy is often considered an effective method for resolving these relationship problems. It helps people affected learn to communicate better and foster understanding with one another, which in turn improves their intimacy.²

Understanding Low Libido

Many factors can contribute to the cause of low libido, including physical conditions, psychological issues, and relationship problems. Addressing these can improve the person’s sex drive.³

Hormones

Hormones such as testosterone and estrogen play a major role in a person’s sex drive. Estrogen typically affects vaginal lubrication in women and overall sexual desire; low levels of estrogen can cause vaginal dryness, which makes sex uncomfortable and ultimately leads to low libido. Many women experience reduced estrogen levels during menopause, which explains the symptoms of low libido they experience.⁵ 

Testosterone is another hormone that is essential for both men's and women’s sex drive; however, this is usually higher in men. Low levels of this vital hormone can also cause a low libido.⁶

Underlying health conditions

In addition, various health conditions could contribute to low libido, for example, diabetes, cancer, heart disease, respiratory issues, and thyroid problems, which could cause fatigue, thereby decreasing the person’s sex drive. While managing these health conditions, a person is likely to be taking medications with side effects that could lead to low libido, such as blood pressure medication, hormonal birth control, strong painkillers, etc.^3,7

Medication side effects

Certain antidepressant and antipsychotic medications are known to have side effects that negatively impact a person’s sex drive. Although these medications are beneficial for managing conditions such as bipolar disorder, anxiety, and depression, they can cause low libido. Hence, healthcare providers must ensure their patients are aware of the various treatment options available, including different types of therapy, to avoid exposure to side effects wherever possible.^5,7,11

Lack of communication

Communication problems and misunderstandings are usually the main causes of a lot of relationship problems, including low libido.¹² Sometimes it may be stress from work, financial problems, or other life issues, such as past trauma, that may trigger these misunderstandings, leading to unresolved conflict. 

Unhealthy lifestyle

Other factors, such as an unhealthy lifestyle, can cause low libido, for example, smoking, consuming excess alcohol, or drug misuse. 

However, there seems to be a link between physical and psychological factors and their effect on sexual desire.^13,1 Several research findings have concluded that the diagnosis of a health condition can trigger anxiety in a person, which could lead to stress and result in a lowered sex drive.¹⁵ In a relationship, the person affected with low libido may begin to have low self-esteem or feel inadequate if unable to meet their partner’s sexual needs; while the partner who is not affected by the condition may feel neglected or undesirable due to the decline in their intimacy.^16,17 This is a major reason why couples therapy would be beneficial in such cases, as it helps rebuild intimacy by addressing communication issues and promoting better understanding, providing a safe environment to express their sexual wants, concerns, and expectations.^18,3,19

What is Couples Therapy, and how can it address Low Libido?

Couples therapy is a type of psychotherapy that helps couples improve their communication, address misunderstandings, and barriers that may be causing distance. It provides a safe place to explore strategies to promote better connection and intimacy. It is also referred to as relationship or marriage counselling.^20,21

There are various types of couples therapy; however, when it comes to addressing sexual issues, these are the main recognised practices:

Emotion-Focused Therapy (EFT)

EFT is a short-term type of therapy that is aimed at improving the emotional bond between couples by observing how they interact with one another, how they manage their emotions within the relationship, and empowering them to cultivate emotional intelligence, which ultimately promotes trust and a deeper understanding of each other.^23,24

Cognitive Behavioural Therapy (CBT)

CBT is a type of talking therapy that focuses on how a person thinks, processes their thoughts, and how they act. It aims to observe the connection between a person’s thoughts and behaviours while providing tips on how to break negative thought patterns and develop healthy coping mechanisms to prevent returning to old habits. When adapted for couples, CBT helps address each person's negative behaviour cycles that have been contributing to low libido, such as low self-esteem, unrealistic expectations, performance anxiety, and depression.^22,25

Sex therapy

This type of therapy specifically focuses on the couple's sexual health, including identifying any sexual dysfunction or intimacy issues, by creating a supportive environment to learn methods that lead to a healthier sex life. It aims to use techniques that educate couples about sexual concerns, such as arousal, pain, and orgasm, and introduce strategies that promote sexual satisfaction by reducing overall sex-related distress.^18,5

Regardless of the type of therapy a couple may choose, the goal of the therapist involved in their treatment will be to implement activities that:^20,22,26

• Improves communication and emotional intimacy
• Identifies and resolves underlying relationship conflicts
• Addresses psychological barriers related to sexual desire
• Educates couples about sexual health and expectations
• Encourages mutual understanding and empathy

When to Seek Couples Therapy

Couples therapy is usually recommended when low libido is the primary cause of distress in the relationship. In situations where low libido frequently leads to conflict and impacts each person’s mental health, and the couple is unable to resolve their issue independently, therapy becomes a beneficial option to consider. The therapist may also advise the couple to consult further medical intervention if the cause of low libido is linked to medication side effects or other medical conditions.^7,19,26

Practical Steps in Couples Therapy for Low Libido

Here are some practical steps to improve intimacy between couples:

• Communication exercises - a safe space for couples to have honest and open conversations, learn active listening, and practise empathy when concerns about their sex life are being addressed
• Assessment and goal-setting - identifying specific triggers related to low libido and planning activities that help rebuild intimacy, such as dating and non-sexual exercises that build an emotional and physical bond, like cuddling
• Sensate focus - a technique used in couples sex therapy to enhance the sensation of touch to reduce performance anxiety and build trust, rather than focus on achieving arousal or orgasm, for example, couples massaging each other
• Homework and future/ongoing practices - the therapist and the couple will work together to create a plan of action to continue implementing even after therapy sessions end, to maintain the results achieved, and combat low libido^25,26,28

Effectiveness of Couples Therapy for Low Libido

Research suggests that couples therapy is effective in managing low libido as it provides a safe space for couples to communicate better, foster understanding and intimacy, which ultimately promotes sexual satisfaction, even when the type of therapy chosen is not successful in treating the low libido issues, especially with underlying health conditions. 

In such situations, where a medical condition is the cause of low libido, couples therapy on its own may not be effective. A combination of couples therapy and further medical intervention, such as a change in current medication or treatment regimen, may be needed to treat or manage the issue of low libido. 

Ultimately, the most effective treatment for low libido depends on the underlying reason and which options the couple decides to commit to. Factors such as the couple's commitment to attending therapy sessions and involvement in the exercises, as well as the therapist’s methods, can affect how beneficial therapy will prove to be for managing low libido.^3,13,26,28

Summary

Couples therapy is beneficial for addressing low libido, as it helps the person affected and their partner rebuild their intimacy by identifying and understanding the underlying causes of low libido, enhancing their communication methods, and developing strategies that will work best for them to achieve better sexual satisfaction. Seeking input from a professional therapist would be most beneficial for gaining insight into the overall condition and providing support in managing low libido, leading to a better quality of life and a healthier relationship.