Low libido

Libido, or sexual desire, naturally varies between people and over time. There's no "normal" amount of desire. Some people want sex often, others rarely, and many fall somewhere in between. A loss of libido is a change from your own baseline, or a level of desire that bothers you.

When low desire is persistent, causes significant distress and isn't better explained by another condition, a clinician may describe it as hypoactive sexual desire disorder in men, or female sexual interest/arousal disorder in women, according to current diagnostic manuals. These labels are only used when the person themselves is distressed; simply having little interest in sex is not a disorder.

It's also important to distinguish low libido from asexuality, which is a sexual orientation describing people who experience little or no sexual attraction. Asexuality isn't something to treat. The key question is whether you are happy with your level of desire.

Low libido usually has more than one cause. Possible factors include:

Physical:
- Hormonal changes, such as during pregnancy, after childbirth, while breastfeeding, during perimenopause and menopause, or with low testosterone
- Chronic illnesses, pain or fatigue
- Side effects of certain medications, including some antidepressants and hormonal treatments
- Alcohol or drug use
- Sleep problems

Psychological:
- Depression, anxiety and stress
- Low self-esteem or body image concerns
- Past sexual trauma or negative experiences
- Performance anxiety or fear of pain

Relationship and life factors:
- Conflict, resentment or lack of emotional connection
- Poor communication about sex
- Routine, exhaustion from work or caregiving, and lack of privacy

Because so many factors interact, a medical check-up is a sensible first step, alongside exploring emotional and relational causes.

Low libido in women is frequently discussed because hormonal transitions, such as postpartum and menopause, can affect desire, arousal and comfort. Pain during sex can understandably reduce interest. Many women also experience responsive desire: interest that builds once intimacy begins rather than appearing spontaneously. Understanding this can relieve a lot of pressure.

Men also experience low sex drive, though they may feel more reluctant to talk about it because of cultural expectations. In men, low desire can be linked to stress, depression, relationship issues, low testosterone or erection difficulties that create anxiety around sex.

In both cases, desire is shaped by context: feeling safe, connected, rested and free of pressure tends to help. Shame and blame tend to do the opposite. There's no need to compare yourself with others or with what you see in media; what matters is what feels right for you and your partner.

Mismatched libido, when one partner wants sex more often than the other, is one of the most common issues couples bring to therapy. Neither partner is "wrong." Problems tend to grow when the difference becomes a source of rejection, pressure or avoidance.

A sexless marriage or relationship is often described as one in which a couple rarely or never has sex. For some couples, this is a mutual and comfortable choice. For others, it leads to loneliness, resentment and conflict.

Patterns that often help couples include:

• Talking openly about desire without blaming
• Broadening intimacy beyond intercourse, such as affection, touch and time together
• Reducing pressure, including taking sex off the table for a while in some therapeutic approaches
• Addressing underlying conflict, stress or practical barriers

A couples therapist or sex therapist can help partners understand each other's needs and find workable solutions.

Treatment depends on the causes. It often combines medical and psychological care:

• A physician can check for hormonal, medical or medication-related factors and suggest adjustments when appropriate. Never stop or change prescribed medication without speaking to the prescriber.
• Sex therapy, provided by a licensed therapist with specialized training, helps individuals and couples explore beliefs, anxieties and communication around sex, often with structured exercises to do at home.
• Cognitive behavioral therapy (CBT) and mindfulness-based approaches can reduce anxiety and help people reconnect with bodily sensations.
• Couples therapy addresses relationship dynamics that affect desire.
• Treatment of depression, anxiety or trauma, including trauma-focused therapy, can improve desire when these are involved.

In some cases, medication may be considered by a doctor. In the first therapy session, expect questions about your sexual history, relationship, health and what you'd like to change. Professionals are used to these conversations, and you set the pace.

Consider seeking support if:

• A change in desire is bothering you or lasts several months
• It's causing tension, distress or distance in your relationship
• You experience pain during sex
• You notice signs of depression, anxiety or other health concerns
• Past experiences make sexual intimacy feel frightening

Meanwhile, look after sleep and stress, reduce alcohol, and try talking with your partner about what helps you feel connected. Choose a calm moment outside the bedroom for that conversation, and focus on curiosity rather than blame. Scheduling relaxed time together, without the expectation that it must lead to sex, can also ease pressure and bring back a sense of closeness.

If sexual experiences have ever been forced or unwanted, a trauma-informed therapist can help you work through their impact safely. Low libido is common and treatable, and asking for help is a sign of caring for yourself and your relationship.