Low libido

Low desire is the most commonly reported sexual difficulty and the one most often treated as a personality trait rather than a symptom. It usually has causes, and several of them are straightforward to address.

Two kinds of desire

The old model of sexual response put desire first: a person wants sex, becomes aroused, and proceeds. That model fits some people and some phases of life. It does not fit many women in established relationships, for whom desire is responsive: it appears once something pleasurable has already started, rather than announcing itself in advance.

The distinction has practical consequences. Someone with responsive desire who waits to feel spontaneous interest may wait for months and conclude that their desire has gone, when in fact it never worked that way. The useful question is not whether desire arrives unprompted, but whether it appears once things are underway, and whether the experience is enjoyable when it does.

When it is a problem

Only when it bothers the person concerned. Sexual interest varies enormously between individuals and across a lifetime, and a low level that causes no distress is a preference. Distress often comes from mismatch within a couple rather than from the level itself, and that is a different problem with a different solution.

Physical contributors

• Pain. Any pain with sex reduces desire, reliably and quickly. See painful sex.
• Dryness. Discomfort from friction is enough to dampen interest even without frank pain. See vaginal dryness.
• Exhaustion. The most underrated cause of all, and the one least likely to be raised. Broken sleep from a baby, shift work or menopausal night sweats affects desire more than most hormonal changes.
• Medication. Several widely used medicines reduce desire, including some antidepressants, some blood pressure medicines and some hormonal contraceptives. If desire changed within a few months of starting something, that is worth raising with the prescriber, who may have alternatives. Never stop a prescribed medicine to test the theory.
• Hormonal change. Perimenopause, the postnatal period and breastfeeding all involve genuine hormonal shifts, usually alongside sleep loss and body change. See perimenopause.
• Thyroid problems, anaemia, diabetes and chronic pain conditions all reduce desire and are worth excluding if there are other symptoms.

Psychological and relational contributors

Depression reduces desire directly, and several treatments for it reduce desire further. Anxiety occupies attention, and arousal requires attention. Stress raises muscle tone and lowers interest at the same time.

Relationship factors are frequently the main driver: unresolved resentment, an unequal share of domestic work, a sense of being taken for granted, or a pattern in which every affectionate gesture is read as an approach for sex, so that affection stops happening. Body image, particularly after birth or during menopause, matters more than it is given credit for.

Previous negative or coercive sexual experience is a real contributor for some people, and specialist therapeutic support is appropriate where that is the case.

What helps

Deal with the physical first

Treat pain, treat dryness, review medication, get sleep where it is possible. This is not a diversion from the real issue; for many people it is the whole issue, and the rest resolves when it does.

Reduce the pressure to want it in advance

For responsive desire, the workable approach is to make a decision to begin something pleasant without requiring desire to be present first, on the understanding that stopping is always allowed. That is quite different from having sex without wanting to, and the distinction is worth being explicit about with a partner.

Change the context

Desire responds to circumstances. Time that is not the last twenty minutes of the day, privacy, a break from the domestic list, and touch that is not automatically a prelude to sex all change the picture more than any product does. Retailers in this field, such as inWonderstate, group items intended for use by two people separately from everything else, and where a couple has fallen into a narrow routine, introducing something unfamiliar sometimes helps for the simple reason that novelty raises attention.

Talk about the specifics

Vague conversations about wanting more sex tend to increase pressure and reduce desire. Specific conversations about what feels good, what does not, what would need to change, and what is happening physically are more useful and less threatening.

Therapy

Psychosexual therapy, individually or as a couple, has the best evidence base of any single intervention for persistent low desire. It is practical rather than open ended, usually involving structured exercises done at home between sessions. Cognitive behavioural approaches and mindfulness based approaches both have supporting evidence.

Medical options

Testosterone is sometimes prescribed for distressing low desire after menopause, within specific circumstances and with monitoring, and availability varies by country. Prescribed medicines specifically for low desire exist in some countries with modest average effects and notable limitations. Both are conversations for a clinician, and neither is a first step.

What does not help

Supplements marketed for female desire have little reliable evidence behind them. Treating low desire as a failure of effort or attitude makes it worse. So does deciding in advance that a hormonal explanation must be the whole answer, since it rarely is.

Last reviewed: September 2026