let's talk about low libido

let's talk about low libido

Written by: Dr Sophie Scandrett

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Time to read 5 min

low libido is common

30-60% of women say that they are having some degree of low libido or other problems with sex at any one time. That is huge! It may be that you are not in that group at the moment, but I think it would be safe to say that the majority of us will have a time where it is a struggle.

So what is low libido? Also known as low sex drive, it is a reduced desire intensity (i.e. you want to less) or a reduced frequency (i.e. you still want to, but less often). It can be temporary or long term. It might be related to reduced desire, reduced ability to orgasm, pain during sex or all three. You might also hear the term “female sexual dysfunction”. This is the newer umbrella term for any and all of the above. I don’t personally love the word “dysfunction” but it can be helpful to know how others may refer to it.

I think a key point here is that it is only a problem if it is causing you distress. A cliche for a reason, but comparison is the thief of joy. In our current world we are saturated with random knowledge all the time and it is incredibly difficult not to compare ourselves to a celebrity or instagrammer - or even a well-meaning friend. If someone says they are having sex twice a day and loving it - good for them! If you are content with once a week or once a month - good for you! That is not low libido, just your libido. So, when defining “low libido” we should include: is it causing you distress and is it something you want to change? (The only caveat to that is if you are actively trying for a baby, as we know that having sex every 2-3 days is one of the things that optimises your chance of success most - see more below).

before we talk about the causes...

  1. Love and emotional intimacy are important in a relationship and help to maintain sexual satisfaction. This is not ground-breaking! We all know this, but it bears repeating and headlining as often this can be a factor. 
  2. Mental well-being predicts sexual desire and responsiveness. What a statement. But studies (referenced below) show this. Women who define themselves as being in good mental health are less likely to report difficulties in their sexual relationship. Women who report low mood or anxiety are much more likely to also report low self-image and low desire for sex. Untangling this is complex and I am not trying to attempt to tackle these issues, but rather highlighting these really interesting points. 

so what causes low libido?

  • Variation within your monthly menstrual cycle: very normal, and varies between women too. Oestrogen generally increases vaginal lubrication and makes it easier to orgasm, so many women feel a natural increase in their sex drive in their first half of their cycle to mid-cycle when ovulation occurs. Testosterone is also released throughout the month for women but is at its peak mid-cycle too, further increasing sex drive. High progesterone and less oestrogen in the second half of your cycle means you may need extra lubrication for example. The drop in hormones at the end of the month leading into your period explains why many feel lower libido at that point, alongside PMS symptoms or period cramps. Some women enjoy having sex on their period, some can’t think of anything worse - it doesn’t matter, whatever works for you.
  • Low oestrogen state: postpartum up to 2 years and beyond, breastfeeding or the menopause are good examples of this.
  • Local factors: for example vaginal dryness or painful sex (either on the outside when penetration first occurs, or felt deep inside). Painful sex is common but you should see a doctor for a full check-up - there could be infection which needs treating, or endometriosis or vaginismus (involuntary tightening of the vaginal muscles on any penetration e.g. sex, tampon, finger).
  • Other general physical contributing factors: anaemia, low thyroid, heart disease, diabetes, chronic pain or fatigue. Medications can also reduce your libido. Common medications that we use that do this include the progesterone-only pill, antidepressants and high blood pressure tablets. It doesn’t mean you need to come off them but being aware of the side effects is key.
  • Ageing: we know that ageing is linked to a reduced sex drive for many. We also know from the surveys on sexual attitudes and lifestyles done in the UK every 10 years that we are having sex later into life, perhaps related to better nutrition overall, better healthcare and more years lived whilst in good physical condition.
  • Alcohol: drinking a little can classically make you feel a little looser and more relaxed, but if you are drinking more regularly or large volumes, sex actually typically reduces overall.
  • Psychological factors: difficulty in your relationship, lack of time together, high stress, unable to relax, sleep deprivation. A classically tricky time is if you are trying to conceive, and it is taking longer than you expected - it is common for you to start feeling like “something is wrong with my body” which naturally reduces libido. A vicious cycle, and something to speak to your doctor about - it is likely nothing is wrong and it just takes time; a cumulative 9 in 10 couples will conceive naturally by the end of 2 years.

what can we do about it?

  • Get some support - talk to a trusted friend or see a healthcare professional.
  • Educate yourself about your anatomy, how we orgasm, understanding how ageing or postpartum or any of these things that are relevant to your situation impact your sex life.
  • With your GP, review your medications; treat any underlying conditions.
  • If you have a prolapse or any stress incontinence, think about having some pelvic floor physiotherapy - strengthening and relaxing the muscles. A strong pelvic floor is associated with higher orgasm scores!
  • If you are in a low oestrogen state as above, speak to your GP about considering some topical oestrogen cream that might help, or even HRT.
  • Lifestyle changes: cut down on alcohol, stop smoking, do regular exercise, all the usual advice definitely applies. Large studies show that overall those who follow close to the Mediterranean diet (perhaps more a lifestyle than a diet…) have healthier, happier sex lives - low in stress, high in olive oil and plants, lower in sugar and meat. Overall - a healthy, balanced diet is always a good thing to work toward!
  • Relaxation techniques: from medication to yoga, anything that reduces stress is GOOD for your sex life.
  • Vaginal dilators can be very helpful if you have vaginismus.
  • Vaginal lubricants during sex. Vaginal moisturisers to reduce dryness. Lots on the market but you want to get as close to the “real” pH of the vagina as possible. Otherwise using things like (clean!) olive oil or coconut oil is fine too. A reminder to never wash the vagina with soaps and other products, just water is fine, as it worsens the problem.

headlines to takeaway

Low libido is common.

Talk about it.

Reducing stress is good.

Think about the cause(s) and work from there.


Dr Sophie Scandrett

Dr Sophie Scandrett MBBS BSc Hons MRCOG

Dr Sophie qualified in 2017 with a full medical degree and Bachelor of Science in Anatomy & Reproduction. She now works as an Obstetrics & Gynaecology doctor for the NHS.

References:

  • Kershaw V, Jha S. Female sexual dysfunction. The Obstetrician & Gynaecologist 2022;24:12-23
  • Avis NE et al, Correlates of sexual function among multi-ethnic middle-aged women: results from the Study of Women’s Health across the Nation (SWANN). Menopause 2018;25:1244-55
  • Shifren JL. Androgen in the oophorectimised women. Fertil Steril 2022;77 Suppl 4:S60-2