Sex drives, like many things in life, experience waves. Sometimes you're deliriously in the mood, and other times, well, even the sexiest moment with your desiring partner barely elicits an internal, “meh.” It’s completely normal to go through moments of high and low libido; the issue is when you get stuck on either end and can’t seem to find a way out. Today we’re focusing on libido drops, specifically. By understanding what the most common causes of low libido are, the more equipped you’ll be to dig yourself out of the ditch. Here, experts explain what can contribute to low libido, plus what you can do to help improve your sexual desire.
Stress and anxiety
Chronic stress and anxiety can result in a libido nosedive. Given the state of the world right now—a pandemic, exhausting political cycle, and unprecedented pressure around work and family—many people are dealing with ongoing stress. “Sometimes when people are stressed, they don’t feel horny; for others, sex is a way to deal with stress,” notes Dr. Sophia Yen, MD, CEO of Pandia Health and clinical associate professor of pediatrics at Stanford Medical School.
Research shows that chronic stress affects the concentration of sex hormones, causing lower levels of genital arousal in women. Too much stress also causes distractions during intimacy. “It’s important to decrease the stress as much as possible—exercise, meditate, listen to calm music, take a warm bath, or surround yourself with lavender diffusers and lavender candles.” A conversation with your doctor can also help.
Feeling pain during intercourse is another reason why you might experience decreased desire. “If sex hurts, why would you want to be uncomfortable?” says Mary Jane Minkin, OBGYN with Yale University’s School of Medicine. For many women the cause of such pain is often vaginal dryness, she explains, adding that a vaginal moisturizer like Replens can be very helpful.
“Women who are trying to conceive may also have trouble lubricating, as they are often having ‘sex on demand’ in order to maximize their chances of hitting the time of ovulation," Dr. Minkin explains. "For these women, using a lubricant like Pre-Seed can be very helpful since it's sperm-friendly, unlike many traditional lubricants.”
Other causes of pain might include pelvic floor dysfunction, labia tearing, STDs or infections, involuntary tightening (vaginismus), polycystic ovary syndrome (PCOS), and endometriosis. These are all topics that should be discussed with your gynecologist or general practitioner.
There are a number of medications that can disrupt your desire to have sex, either directly by affecting your hormone levels or indirectly. One of the most common categories is antidepressants (specifically, SSRIs and SNRIs). “If you are on an antidepressant and experience decreased libido, talk with your provider about changing to a different one,” says Dr. Minkin.
Other medications that may decrease sexual desire include heart and blood pressure medications and certain steroids, as well as cancer treatments like radiation. Anti-histamines, aka allergy medicines, have also been shown to temporarily lower libido; though once they are out of your system, things should return to normal.
Speaking of medication, birth control can also affect your sex drive, notes Dr. Yen. “It depends on the progestational effect and the androgenic effect of the pill. The higher the androgenic level of the pill, the more libido; the lower the androgenic level, the less libido," she explains. (Note: If you are using hormonal birth control for the treatment of acne, it is likely the latter.) If low libido seems to be a side effect of your contraceptive, Dr. Yen suggestions asking your OBGYN for a more androgenic progestin, or perhaps increasing your current dosage to kick libido back to its baseline.
Women undergo major hormonal shifts throughout their life, including during perimenopause and menopause, pregnancy, and post-pregnancy. Even coming off your birth control or starting a new one, as mentioned above, can have an impact on your hormone levels.
First, let’s talk about menopause. “Hormonal fluctuations during this time period can impact interest, and/or cause change to the vaginal tissue, which might make having sex less enjoyable,” explains Kecia Gaither, a double board-certified OBGYN and director of perinatal services at NYC Health + Hospitals/Lincoln. Specifically, women who are menopausal (or perimenopausal) often experience a thinning of vaginal tissue and decrease in natural lubrication due to estrogen drops. Try using a lube, such as Champ's hypoallergenic Water-Based Lubrican ($18), to decrease discomfort.
Dr. Minkin adds that women who have just given birth and/or are breastfeeding might also experience decreased lubrication. In terms of hormones, estrogen and progesterone levels drop dramatically right after birth, which can cause a surge of emotions ranging from irritability to postpartum depression. It’s also completely normal for women who’ve just given birth to feel exhausted and laser-focused on taking care of their newborn. So, in other words, intimacy may not be top of mind during this time.
An underlying medical illness
“Medical illnesses, like hypertension, diabetes, neurological diseases, and cancer can impair sexual desire and function,” says Dr. Gaither. If you’ve already been diagnosed, speak with your doctor about ways to improve your sexual appetite. If you suspect you have an underlying medical issue, it’s important to address and manage that first, and then have conversations about how it might affect your libido and the appropriate treatment.
You aren't enjoying sex
Let’s draw an analogy: You’ve got a box of cookies in front of you that look and smell great, but every time you take a bite of one, it’s bitter. Why reach for a bitter cookie? The same thing can happen in your sex life. “Did you know that in any heterosexual encounter, the person with the uterus only orgasms 65 person of the time?” points out Dr. Yen. “If your partner isn't getting you excited, you're not receiving pleasure or your partner finishes before you orgasm, then you might not be easily aroused.”
The solution, she says, is to improve the communication with your partner. Be clear about any issues in the bedroom, as sex should be a shared experience that's equally enjoyable. If you are in a heterosexual relationship and find that your partner ejaculates too soon, try condoms that numb the penis or climax-control lubricant with benzocaine, suggest Dr. Yen. "The medication is a numbing agent, so the man lasts longer—ideally until you get to orgasm," she explains.
Of course, you might not enjoy sex for reasons beyond lack of orgasm. For example: monotonous intercourse, sex that’s too rough, or a general lack of intimate connection. Again, communication is key here. Start by talking to your partner; if the issues persist, you may want to consider relationship counseling. Sexual trauma, feelings of shame, and body image issues can also contribute to low libido. In this case, it's important to speak to a mental health expert; they will help you work through these thoughts and feelings so you can better enjoy sex.
Addressing low libido
In addition to tackling stress and anxiety, communicating more clearly with your partner, addressing vaginal dryness, and speaking with your doctor about medical issues you might be experiencing, you can also consider medications to help improve your sexual desire. “There are some medications and over-the-counter products that can help with libido,” says Dr. Minkin.
A great over-the-counter product is Ristela, which can be used in women who are pre- and post-menopausal, Dr. Minkin explains. Prescription medications include Vyleesi and Addyi, which are approved for use in pre-menopausal women, while postmenopausal women may benefit from testosterone therapy, she says.
At the end of the day, know that you’re not alone, and we all experience waves when it comes to sexual desire. Listen to your body, speak with professionals, and continue taking care of yourself mentally and physically.
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