Low libido in women: Symptoms, causes, & treatment

What is low libido?

Low libido is a term used to describe a low level of interest or desire for sex [1]. As for what constitutes low, that is very personal to each individual. For many people, having a low sex drive is no big deal, whereas for others, it can cause stress or anxiety. 

There is no right or wrong amount to want to have sex, and “low” is whatever feels low for you. It is perfectly healthy to not want sex very much or to want it a lot, as long as it doesn’t get in the way of you enjoying the other aspects of your life. 

How common is low libido in women?

Low libido affects many of us at one stage or another, and is probably more common than you might think. A review of existing literature found that low libido is the most common sexual difficulty reported by women [2]. Low libido is also more common as we age. One study of over 2,000 women in the US found that reports of low sexual desire ranged from 26% in premenopausal women, up to 52% of those who had reached menopause [3]. 

Symptoms of low libido

Low libido can feel different from person to person, but the most common symptoms are [1]: 

• Feeling no interest in any type of sex, including masturbation
• Rarely, or never, thinking about sex or having sexual fantasies
• Being unhappy with having a low sexual desire

You might feel your symptoms come and go, are triggered by something in particular, or that they are constant. This will depend on the cause behind your low libido (more on this below). 

Why is my sex drive low?

The causes of low libido range from temporary hormonal changes to mental health issues to medications. Here are some of the most common causes:

Physical health conditions

A problem with your physical health may be causing your low libido, such as: 

• Chronic medical conditions: Low libido can be a side effect of certain conditions, including cardiovascular disease, diabetes, and obesity [4].
• Medication: Antidepressants, antipsychotics, beta blockers, opioids, and hormone therapies may cause low libido [4, 5].
• Alcohol and drugs: Drinking too much alcohol and using recreational drugs are also linked to lower sex drive [4].
• Sexual problems: Low libido can occur as a knock-on effect from conditions affecting sexual function, such as dyspareunia (pain during sex), vaginal dryness, or vaginismus (when the vagina tightens and closes as you try to put something in it) [4, 6].

Mental health conditions

Our mental health can have a huge impact on all areas of our lives, including our sex drive. Many common mental health problems can cause low libido, such as: 

• Stress: Chronic stress affects libido in two ways: hormonal, through high cortisol levels, and psychological, i.e., feeling distracted [7].
• Depression and anxiety: A 2018 review on this subject found that those with depression or an anxiety disorder are at higher risk of sexual dysfunction, including low libido [8]. 
• Past sexual trauma: Negative sexual experiences, including post-traumatic stress syndrome (PTSD), trigger low libido due to negative associations [1].

Relationship issues

Sometimes, emotional problems in your relationship can lead to a lack of interest in sex. It could be that you and your partner are lacking intimacy, or are recovering from previous problems relating to sex. Or, you might have worries unrelated to sex, such as a lack of trust in the partnership [9]. 

Unfortunately, there is sometimes a spiral effect, whereby relationship issues cause low libido, and low libido puts further strain on the relationship. It might seem like the more sex a couple has, the closer they are, but that is not the case. Frequency of sex does not determine the success of your relationship, and physical intimacy doesn’t always mean sex. Cuddling, hugging, and hand-holding are all ways to experience intimacy without sex. Many couples who have strong relationships do not necessarily engage in lots of sex — and vice versa. Your experience with your partner and what you consider the “right” amount of sex is unique to your relationship. Remember, all sexual activity, including kissing, should always involve explicit consent from each partner.

Hormonal changes

Hormones are at the core of our reproductive and sexual health. Any disruptions to those hormones, whether natural or due to a hormonal condition, can affect our libido. 

Temporary changes in sex drive are common as we move through the phases of our menstrual cycle and the associated hormone fluctuations. At the end of the follicular phase is ovulation, the time we are at peak fertility (near the end of the fertile window). At this stage, many individuals report high libido and sexual arousal. Conversely, in the early follicular phase and in the luteal phase (after ovulation), fertility is low, and many report a decrease in libido [10]. 

During pregnancy, your hormone levels change as your body nourishes the growing fetus and prepares for birth. Testosterone is a notable sex hormone that increases during pregnancy, and one study found a correlation between increased testosterone and lower libido [11]. After pregnancy, hormones take a while to rebalance, and it is not uncommon to experience low libido post-birth. Prolactin levels are also high to facilitate breastfeeding. However, higher-than-usual levels (known as hyperprolactinemia) can also lead to lower libido. Low sex drive after birth may also be related to the physical recovery of your body post-birth [12]. 

As we go through perimenopause — the period of time before menopause, or the end of our fertile years — our estrogen levels fluctuate more erratically. Estrogen plays a crucial role in arousal and sex. It is responsible for lubrication during sex and contributes to sexual desire, and it is not uncommon to experience low libido as estrogen fluctuates during this time. Additional perimenopause symptoms, such as night sweats or hot flashes, can also further impact libido [3, 13].

There are also endocrine conditions that affect our hormone levels and libido. Polycystic ovary syndrome (PCOS) is a gynecological condition impacting ovarian function. Though the exact cause of PCOS is still unknown, we are aware it is related to abnormal hormone levels, including androgens (male sex hormones) and insulin [14]. A study of 130 married women with PCOS who were referred due to infertility found that almost all individuals experienced problems with sexual desire and arousal [15]. Both hypothyroidism (an underactive thyroid) and hyperthyroidism (an overactive thyroid) are also found to negatively affect female sexual function, including arousal, with low libido being a well-documented side effect of the former [16].

Birth control and low libido

Contraception may play a part in low libido, too. Hormonal birth control, such as the pill, patch, implant, or hormonal IUD, contains progesterone or a combination of progesterone and estrogen, which we now know can affect libido. While more research is needed, some women have reported a decreased sex drive as a side effect of taking oral contraceptives [17, 18]. 

Diagnosing low libido in women

If you are concerned about low libido, the first step is determining the root cause. Your doctor will likely conduct an initial evaluation of your symptoms, known health conditions, current medications, past and present sex life and relationships, stress levels, and thoughts on sex. 

If your doctor thinks there may be an underlying condition affecting your libido, they may ask to do tests. These can include a general physical assessment, pelvic exam, blood test, or an ultrasound or X-ray. 

Treating low libido

There are lots of treatment options available for low libido, depending on the cause. Several types of therapy are available to help you address relationship issues, including couples counseling, whilst cognitive behavioral therapy (CBT) or antidepressants may be recommended to address anxiety or depression. If your sex drive is affected by medication, your doctor may be able to offer an alternative. You can also speak to your doctor about switching birth control if you think this is the cause of your low libido. If you have a health condition causing low libido, your doctor may be able to prescribe medication to help counter this. Some people struggling with perimenopause may find relief from hormone replacement therapy (HRT). 

Tips for improving your libido

Struggling with low libido can be tough, and sometimes it can feel out of your control. But here are some small tips to help work towards a higher libido. 

Determine the cause 

The first step to improving your libido is to determine what is causing it. Low libido caused by anxiety or trauma needs a different approach than if it is medication or a physical health condition. If you are unsure of the cause or don’t know where to start, speak to your healthcare provider. 

Maintain a healthy lifestyle

A healthy daily lifestyle can help you cope with many factors contributing to low libido. Regular exercise can help reduce stress, manage weight, and lower your risk of cardiovascular conditions and depression [19]. Eating a balanced diet with lots of whole foods and restricting red meat, processed sugars, and trans fats can reduce your risk of developing diabetes or help manage existing diabetes symptoms [20]. If you regularly consume alcohol or take recreational drugs, you can try stopping or reducing your intake [4]. Speak to your doctor if you need help, or reach out to organizations such as Alcoholics Anonymous or Narcotics Anonymous. 

Try hormone-free birth control

If hormonal contraception is causing side effects such as low libido, there are lots of options available. You might consider a lower dose hormonal birth control, or consider hormone-free options such as Natural Cycles. The NC° app is the first FDA-cleared birth control app that uses biomarkers and a unique algorithm to determine which days are the safest for you to have unprotected sex. Going hormone-free and encouraging a deeper connection with your body might just increase your libido. In a survey of users who switched from hormonal contraception to Natural Cycles, sexual desire and partner attraction increased, on average, within three months [18]. 

Talking it through

Living with low libido might feel isolating, but speaking to someone can go a long way in helping ease your worries. If you feel comfortable, try speaking to your partner or a friend about your worries, whether directly related to your libido or other concerns that are causing stress or anxiety. Alternatively, you may feel more comfortable taking part in talking therapy, a type of psychological therapy in which you speak to a professional about anything on your mind. This could be particularly helpful if you are unsure what is causing your low libido, or you have specific stresses or trauma you would like to talk through. 

Explore yourself first

If you find your low libido is mostly related to sex with another person, perhaps lean in to exploring your own body first. Pick somewhere quiet where you can relax and explore your body with solo sex. Take a moment to notice what you enjoy, what you don’t, and acknowledge any anxieties. Experimenting on your own could help you determine whether there is a physical cause or learn more about any worries or anxieties behind your low libido. Solo sex is not “cheating” either, and it is perfectly healthy to masturbate while in a relationship.

When to see a doctor

Fluctuations in libido are entirely normal, and what feels like low libido will be different for everyone. It’s important to remember that sex is meant to be enjoyed, and you shouldn’t feel you have to “push through” with having sex when you are not in the mood. Sometimes, it is best to seek professional help from your doctor, especially if [4, 5]: 

• You think your current medication may be affecting your libido
• You feel your relationship or day-to-day life is affected by low libido
• Low libido is impacting your mental health
• You are trying to conceive and are concerned about a low libido
• You are concerned about your libido levels after giving birth

Sex might feel like an embarrassing or tricky topic to discuss. But remember, it is a natural part of life that affects everyone. Doctors are used to discussing these topics and are here to help you.

Learn about your body with Natural Cycles

If you think your low libido may be caused by your birth control, why not consider going hormone-free? Natural Cycles is the first FDA-cleared, hormone-free birth control app. Using biomarkers and a one-of-a-kind algorithm, the NC° app predicts when your fertile and non-fertile days are, so you know when it is safest to have sex. It also offers a cycle report at the end of every cycle, so you can spot patterns in your symptoms, including libido, and feel empowered when you speak to your doctor. NC° goes beyond birth control, helping you plan and follow pregnancy, providing postpartum support, and guiding users through perimenopause — whatever stage of life you’re at, find out how Natural Cycles can work for you!