There’s no “healthy” number of times to have sex per week or month or year. Everyone has a different level of libido, or sex drive.
“Some people have a high libido and love it; some people have a low libido and are happy with that,” says UNC Health family nurse practitioner Karley Bastien. “If it’s not distressing to you, it’s normal.”
But if low libido is causing you frustration, talk to your healthcare provider.
“It’s OK to want a different libido, and there are many things we can do to help,” Bastien says. “There are a lot of different reasons for lower libido, so it may take some time. But until you talk about it, we can’t figure out what will be the ticket to help you.”
Both men and women can experience changes and frustrations with their libido; while some of these reasons for lowered libido affect men, we’ll primarily focus on common concerns for women.
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Libido Killer: Hormonal Changes
Your libido is tied to your hormones; testosterone in both men and women and estrogen and progesterone in women. These hormones decrease with age, and for women, there are many shifts over the course of a lifetime.
For example: You may find that you desire sex more frequently at certain points during your menstrual cycle. There are big surges and drops in hormones during pregnancy and the postpartum period. And during perimenopause and after menopause, fluctuations and depletion of hormones can cause a variety of symptoms that might cause your libido to plummet. Lack of estrogen can cause thinning of the vaginal tissue and lead to decreased lubrication, making sex painful. Night sweats and difficulty sleeping can make you too tired for sex.
“You may love your partner, but when you’re sweaty all night, you don’t want to be touched,” Bastien says.
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Libido Killer: Physical Symptoms or Changes
These hormonal changes often cause other physical changes to your body.
“Body image is a huge thing for your libido, and it’s hard to be intimate when you’re not comfortable in your own skin,” Bastien says.
Pregnancy and menopause can change your shape in ways that may take getting used to. Having a history of disordered eating or body dysmorphia can make physical intimacy difficult. Learning you have a chronic illness or struggling with ongoing pain can negatively change your relationship with your body. Some health conditions come with painful sex as a symptom, including endometriosis, vulvodynia, pelvic floor dysfunction, urinary tract infections and gastrointestinal issues.
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Libido Killer: Medications
Multiple medications may interfere with libido, most notably hormonal contraceptives and medications for mood disorders, seizures and blood pressure, Bastien says.
But never stop taking a medication without talking to your healthcare provider.
“You shouldn’t stop a medication if it’s working in other ways,” Bastien says. “Your provider can evaluate if your dose needs to be adjusted or if there’s another option.”
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Libido Killer: Stress or Depression
Life is busy and not always easy. You may be juggling a million things—career, kids, friendships, aging parents, a plumbing disaster—while also trying to make sense of the news of the day.
“Typically, when men are stressed, sex can relieve anxiety, improve fatigue and energize them,” Bastien says. “For most women, it’s usually the opposite. You have to be relaxed, energized and happy before sex. It’s going to be the last thing on your mind after a long day of work, picking up kids, making dinner, cleaning.”
While sex might seem solely physical, there’s a huge mental component. When you’re stressed, it’s hard to be in the mood; when you have mental health challenges such as depression or anxiety, it can seem impossible.
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Libido Killer: Relationship Changes
Sometimes, a lower libido is a sign that you’re no longer attracted to your partner. But in a long-term relationship, it’s normal to have shifts in libido that lead to dry spells.
A new baby, your child’s issues at school or a loved one with cancer might be at the forefront of your attention, not romance. Even when things are going mostly well and you know you love your partner, you might just lack time to connect.
It’s important to understand the two main types of sexual desire: responsive and spontaneous.
“When you look at television or movies, it’s all spontaneous desire. People naturally want to have sex all the time,” she says. “That’s not always a natural phenomenon for women, especially in a long-term relationship.”
While some women do experience high levels of spontaneous desire, it’s more common for women to experience responsive desire, meaning that something has to trigger the desire. That may mean reading or watching a romance, having a regular date night or simply getting a little more help with household chores.
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Libido Killer: Sex Isn’t Enjoyable
If you’re not enjoying the sex you’re having or it hurts, you’re not going to want more of it. Sometimes sex is painful because of a medical condition, and some medications can make it harder to become aroused or achieve an orgasm.
There might be cultural, social or religious reasons at play as well. You might be worried about getting pregnant when you don’t want to be. Maybe you were only taught about certain kinds of sexual activity, and you or your partner may believe those activities should be performed in certain ways. Maybe those ways worked for you in the past, but they’re not working anymore, or maybe it never worked for you, and you’re tired of pretending.
What to Do About Low Libido
Here’s the tricky thing about low libido: It’s extremely unlikely that you’re dealing with only one of the factors above. More commonly, it’s a little bit of everything, and that will take some time for your healthcare provider to untangle. But first, you have to tell them it’s an issue.
“Talk to your provider, and if they dismiss your symptoms or feel they can’t help you, ask for a referral to someone who can,” Bastien says. “It’s OK to want a libido, but don’t be discouraged if you don’t get a definitive answer or treatment right away.”
Your doctor may recommend couples therapy or a sex therapist.
“Even people who say their relationship is great find benefits in working with a professional who can help them rekindle or strengthen their relationship,” Bastien says. “With that time to step back and talk, they usually learn more about what they could be doing together that would help.”
That may mean discussing ways to have more one-on-one time when things are hectic, or redefining physical intimacy and your goals around it.
If you’re depressed, working with a therapist on your own or with your partner can be helpful; while some people are hesitant to take antidepressants because some can lower libido, your provider can help find a solution that works for you. A therapist can help you examine your beliefs about sex and your body, which can be particularly helpful if it wasn’t a topic you received much education about or if you have trauma in your past.
Your healthcare provider can help you work through any physical symptoms to determine if they might be due to a hormonal cause or another physical condition. They can also consider adjustments to your medications.
“For menopause, there’s hormone therapy and nonhormonal options, and we find that libido naturally increases with these,” Bastien says. “For pain with sex, vaginal estrogen cream can help that tissue, as can lubricants and moisturizers.”
Adopting or strengthening healthy habits also can help.
“A healthy diet, exercise, good sleep and limiting alcohol all increase libido and improve body image,” Bastien says.
There are medications that can increase libido in women, but Bastien says they often aren’t covered by insurance. If you are able to afford them, they work best when you’ve optimized the other factors associated with physical and mental health and the state of your relationship.
It can be a long process, Bastien says, but don’t give up.
“I wish I could give you something that would work right away, but have patience,” she says. “Progress isn’t always linear. Keep following up. Your libido probably didn’t disappear overnight, so you won’t get it back overnight.”
If you’re struggling with a lower libido, talk to your doctor or find one near you.