We live in a world where sex matters a lot. It is practised widely in our lives and romantic relationships, it is also heavily featured in the media we consume. Sexual freedom has been celebrated by women more now than ever, and the discussions around sex bring about a sense of empowerment in freedom of choice while raising awareness of health-related concerns commonly encountered during sex. It is even more important to talk about a condition that happens among a lot of women or people assigned female at birth (AFAB), where the drive to have sex is low. This condition is referred to as low libido.
Low libido is a phenomenon that doctors refer to as sexual dysfunction. Typically characterised as a diminished interest in sexual activity, low libido can affect any woman or person AFAB at any stage of their life, no matter their background or age.
The desire to perform sexual acts or have sexual thoughts tends to fluctuate within a person's lifetime and is dependent on a variety of physiological and external factors. It might cause distress or a feeling that ‘something is wrong’ with them.
It can be especially problematic when they are in established relationships, where they feel that due to low sex drive, they do not meet their partners’ sexual needs. Low libido is a complex issue that often presents as a symptom of many underlying issues such as stress, big life changes, or health problems.
In this article, we will try to understand low libido by identifying the core causes and symptoms of low libido in women or people with AFAB. We will aim to provide some possible solutions, including ongoing therapy approaches, to provide solutions and guidance for those in need.
Causes of low libido in women
Psychological factors:1, 2
There are many psychological causes of decreased sex drive in women or people AFAB. If their mind is preoccupied with worries or they are in some kind of distress, their willingness to act sexually can be low. Psychological causes can include:
- Heightened or prolonged stress
- Experiences of anxiety and depression
- Negative body image
- Low self-esteem and negative self-talk
- History of sexual trauma and violence - previous negative sexual experiences can affect how women perceive intimacy and affect willingness to engage in sexual acts
- Poor emotional health
- Relationship issues - when in relationships, issues connected to lack of connection and communication, unresolved conflicts, and trust issues can negatively impact sexual desire
Physiological changes to the body as we age, thereby affecting libido. Furthermore, certain diseases or medications that are taken to tackle those diseases can cause libido to fluctuate. Some examples include:
- Older age - low libido is common among women over 60 years old, as it is directly linked to menopause and fluctuations in hormones such as progesterone and estrogen.4
- Medical conditions - low libido can be one of the symptoms of common medical conditions, such as diabetes, high blood pressure, underactive thyroid, and cancer.
- Taking certain medications for mental disorders - lowered sex drive is a common side-effect of taking antidepressants, especially selective serotonin reuptake inhibitors(SSRI) and antipsychotics.5
- Vaginal dryness can cause pain during sex and/or masturbation - women who experience pain during sexual acts or cannot orgasm can have reduced sex drive.
- Surgery - having an operation followed by a recovery period can mean a reduced willingness to perform sexual acts. This can especially be true when surgeries are performed on organs that are a part of the reproductive system, for example, breasts and genitals.
- Fatigue - prolonged tiredness due to poor work-life balance, relationship problems, or taking care of children, can play a role in low sex drive in women. As a body needs all the energy to stay awake, little is left for sexual desire.
- Lifestyle - poor lifestyle choices can negatively affect sex drive, for example, not enough sleep, drinking too much alcohol, smoking, being inactive, not exercising enough, or a bad diet
Hormonal imbalance, such as changing levels of hormones connected to the reproductive system, such as estrogen and progesterone, can affect libido in women. This can include:
- Hormone-based contraceptives, such as birth control implants, intrauterine devices (IUD), contraceptive pills, vaginal rings, and skin patches. 6
- Menopause - estrogen levels drop significantly after menopause. This can cause women to have less interest in sex. Moreover, menopause is connected to vaginal dryness, which can cause discomfort and itch, making sexual acts painful or not satisfying.
- Pregnancy and breastfeeding - During pregnancy and in the breastfeeding stage, women go through a hormonal whirlwind, which can affect their libido. Additionally, postpartum women might experience fatigue, body image issues, and stress, which can dampen sexual desire.
- Underlying medical conditions, like hyperthyroidism, also contribute to hormonal imbalance.
Signs and symptoms of low libido in women
The main symptoms of low libido in women can include:
- Decreased sexual thoughts
- Less desire or interest in sexual intercourse or engaging in sexual activity
- Difficulty getting aroused
- Lack of enjoyment during sexual intercourse or masturbation
Management and treatment for low libido in women
The treatment available to tackle low libido in women depends on what is the underlying cause of it.
During your appointment with a GP, you can get to the root of a problem, discuss possible treatments, get the necessary advice and help to improve libido.
Here are possible treatments, based on underlying causes of low libido:3
|Underlying causes of low libido
- Talking to a professionally trained therapist who will listen and provide support without judging or criticising
- The counselling session takes place face-to-face or online, with the option of being a one-to-one or session with your partner. Counselling is free with the NHS, and you do not need a referral from the GP.
- Open communication with a partner, healthcare professional, or sex therapist is crucial to get to the root of the problem.
- It also can help you better understand the problem and improve your strategies to manage this condition.
|Vaginal dryness or problems related to the reproductive system
|After an examination by the GP, They will offer you medications depending on the issue. For example, vaginal lubricants might be prescribed for vaginal dryness during sexual intercourse.
|Hormone replacement therapy (HRT)
- Offered to relieve symptoms connected to menopause
- It replaces hormones that are decreased during the process of menopause
- It helps with many symptoms such as hot flushes, vaginal dryness, night sweats, mood swings, and reduced sex drive
|Mental health problems, such as depression
- They improve how mood chemicals work in the brain, such as serotonin and noradrenaline (Called neurotransmitters)
- They have side effects, such as lowering sex drive
Cognitive behavioural therapy (CBT)
- A type of talking therapy that aims to change the way you think and act
- Based on the assumption that all your thoughts, feelings, behaviours and physical sensations are connected to each other and that they can make you feel trapped in a negative loop
- CBT focuses on your current problems instead of focusing on the past, therefore tackling the most pressing issues at the moment.
- It looks for the most practical ways to improve your daily living, for example, how to improve body image, self-esteem and sexual satisfaction to help with a lower libido
|Chronic medication or contraceptives
|- Alerting your GP about low libido would allow your GP to explore other possible treatment options and make adjustments to the current medications to find the best course of action to reduce the side effects of reduced sex drive
|- Adapting a healthier lifestyle carries a high chance of success when it comes to improving sex drive,
- Examples of how to improve your lifestyle: regular exercise, a balanced, nutrient-rich diet, sufficient and regular sleep, and stress management techniques can also contribute to improved quality of life and are linked to improved libido
|Low self-esteem and negative body image
|- Practising self-care activities that focus on mindfulness can help to reconnect the mind with the body and boost emotional well-being
- Self-exploration, such as masturbation or other type of pleasant stimulation, can help in enhancing the sexual pleasure
It is important to consult with a doctor if you are worried about your low sex drive.
It would be a good idea to discuss low libido issues if you are taking chronic medication or using hormone-based contraception. If you experience issues with your sex drive not returning to normal after pregnancy, it would be beneficial to get advice from a gynaecologist.3
How can I prevent low libido in women?
It is a difficult question to answer, as there are different underlying causes of low libido in women. Some examples include:
- Regular exercises: aerobic exercise and strength training can improve stamina, boost mood and manage stress.
- Eat a balanced and nutrient-rich diet
- Getting enough sleep and rest
How common is low libido in women?
A recent study from the UK states that 5.8% of women reported symptoms that can be classified as a symptom of female sexual dysfunction (FSD), including low libido. Over 15% per cent of women stated a lifelong FSD.
Hypoactive sexual desire (low libido) was the most common complaint in the studied group, including 21.4% of respondents in the group who started to have issues with low libido recently. For those women who were struggling with FSD during their lifetime, 17.3% responded that low sex drive was one of the main symptoms.7
Who is at risk of low libido among women or persons AFAB?
Women with underlying health conditions, mental health disorders, and old age are the main cohort that have reported low libido.3
When should I see a doctor?
You should see a doctor if you notice that you do not engage in sexual activities as you used to or have a hard time getting aroused before or climaxing during sexual intercourse.3
Many women or persons with AFAB experience low libido, which can be distressing and has the potential to affect relationships. Low libido, characterized by a diminished interest in sexual activity, can occur at any stage of life and has various underlying causes. Women with underlying health conditions and of older age may be at higher risk of having a low libido.
Psychological factors causing low libido include stress, anxiety, body image issues, and relationship problems can contribute to low libido. Physical causes of low libido can include hormonal fluctuations, health conditions, lifelong medication, fatigue, and poor lifestyle choices. Hormonal imbalances caused by contraceptives, menopause, pregnancy, and breastfeeding can also impact libido.
Treatment for low libido is dependent on the underlying cause. Options include relationship counselling, cognitive behavioural therapy, adjusting medications or contraception and lifestyle changes.
It is crucial to discuss your concerns with a doctor or diagnosis and advice. Preventive measures may include regular exercise, a balanced diet, sufficient sleep, and stress management.
- Bost BW. Fatigue, weight gain, and low libido in women: physician attitudes on cause and treatment. Obstetrics & Gynecology [Internet]. 2002 Apr [cited 2023 Jul 14];99(4):87S. Available from: https://journals.lww.com/greenjournal/Citation/2002/04001/Fatigue,_Weight_Gain,_and_Low_Libido_in_Women_.195.aspx
- Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA. 1999 Feb 10;281(6):537–44.
- nhs.uk [Internet]. 2017 [cited 2023 Jul 14]. Low sex drive (Loss of libido). Available from: https://www.nhs.uk/conditions/loss-of-libido/
- Thomas HN, Hamm M, Hess R, Borrero S, Thurston RC. “I want to feel like I used to feel”: A qualitative study of causes of low libido in postmenopausal women. Menopause [Internet]. 2020 Mar [cited 2023 Jul 14];27(3):289–94. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7047535/
- Liu X, Feng Z, Galling B, Qi N, Zhu XQ, Xiao L, et al. Gender specific sexual dysfunction in patients with depression. Front Psychiatry. 2023;14:1194228.
- Contraception: Hormonal contraceptives [Internet]. Institute for Quality and Efficiency in Health Care (IQWiG); 2017 [cited 2023 Jul 14]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441576/
- McCabe MP, Sharlip ID, Lewis R, Atalla E, Balon R, Fisher AD, et al. Incidence and prevalence of sexual dysfunction in women and men: a consensus statement from the fourth international consultation on sexual medicine 2015. J Sex Med. 2016 Feb;13(2):144–52.