Feeling concerned about a low libido can be such an isolating experience. When your psychological drive to have sex isn’t where you’d hope, you might feel like you can’t even discuss it with a partner—the very person you may normally turn to for basically everything else. But a persistently low libido that bothers you is not something to ignore. Here’s what could be behind a low libido, as well as guidance on who to talk to and how to find them.
Factors that can affect your libido
“There are so many physiological, psychosocial, and environmental factors in a [person’s] life that can have a very strong negative impact on their sex drive,” Leah Millheiser, M.D., clinical assistant professor of obstetrics and gynecology and ob/gyn at the Female Sexual Medicine Program at Stanford Medicine, tells SELF.
Some of the most common libido-killers include stress and fatigue, says Dr. Millheiser. Relationship issues like mismatched expectations about sex or a lack of emotional intimacy can also contribute. Additionally, hormonal fluctuations can sway a person’s libido, including the changes that occur during the menstrual cycle, pregnancy, and menopause, as SELF previously reported. Several common prescription drugs, like some hormonal contraceptives and antidepressants can also affect your libido, according to the Mayo Clinic.
While tons of situational factors can affect your libido, this isn’t always necessarily a bad thing. Maybe you’re currently single, crushing it in like three different areas of your life, and, honestly, sex and intimacy just aren’t top of mind for you right now. If you don’t really feel any type of way about that, carry on!
Conditions that can cause chronic low libido
So, we know there are situational factors that can impact libido, but health conditions can play a role, too. Virtually every aspect of health can impact the physiological and psychological aspects of desire, which in turn can influence each other, Madeleine M. Castellanos, M.D., a board-certified psychiatrist specializing in sex therapy and author of Wanting to Want, tells SELF.
That includes numerous conditions that dampen desire by causing pain during sex, including endometriosis, ovarian cysts, vulvodynia (terrible chronic pain surrounding the vaginal opening), and vaginismus (muscle spasms that make penetration uncomfortable). Circulatory issues caused by conditions such as hypertension, heart disease, and diabetes can result in a lack of sufficient blood flow to the genitals that hinders physical sexual arousal (which can impact the mental portion), according to the Cleveland Clinic. Then there are mental health conditions like depression and anxiety, which can make sex feel like the last thing you want to do.
So what happens if you’re experiencing chronic low libido without any of the aforementioned risk factors? If your libido has been absent for more than six months and you really can’t pinpoint why, you may have a condition called hypoactive sexual desire disorder (HSDD), which some experts think is linked to a chemical imbalance in the brain.
In sum, there are plenty of reasons why you might be dealing with a low sex drive. Figuring it out on your own can be confusing. That’s where experts may be able to help.
When to see someone about a low libido
The expert wisdom here is pretty simple: If you’re distressed about your libido or it’s causing issues in your relationship, it’s time to talk to a pro, Dr. Millheiser says.
Not only could low libido be a sign of an underlying health concern, but enjoying sex regularly can be good for you. “It’s a wonderful connection with another human being, but it’s also an important piece of your health,” Dr. Castellanos explains. In some people, sexual activity can help do things like make you feel great and less stressed, take your mind off menstrual cramps, and maybe even help you get to sleep, as SELF previously reported. Being satisfied with your libido and having a fulfilling sex life can have a positive impact on your psychological well-being, too.
“Don’t put [low libido] on the backburner if it persists,” Dr. Castellanos explains. “The earlier you address it, the easier it is to correct the problem.”
But keep in mind: You should only consider seeing someone about your libido if you view it as a problem. If someone like your partner is trying to make it seem as though your libido isn’t “high enough,” that doesn’t necessarily mean anything’s wrong with you or your sex drive. Your partner might be making assumptions based on their own libido, or maybe your libido really has changed over time but it’s a change that you’re mentally aligned with. While it couldn’t hurt to talk to someone about a change in your libido, you should never feel pressured to do so.
Who you can talk to about libido issues
The person best equipped to help you depends on what’s causing your low libido and your access to care, Dr. Castellanos explains.
If you have no idea where to start: See your primary care provider (PCP) or a general internist. “Any physical condition can affect your desire, so it’s always worthwhile to get that checked first,” Dr. Castellanos says.
This type of doctor can discuss your symptoms, order tests to help you uncover potential underlying medical issues, and refer you to a specialist if necessary.
If you’re having vaginal health issues: See an ob/gyn. Symptoms like pain with intercourse merit an exam and discussion with a specialist, Dr. Castellanos says.
If you’re having mental health issues: See a licensed therapist or psychiatrist. They can help you figure out which mental health condition may be contributing to your low libido and potentially provide a treatment plan.
If you suspect the problem is a medication you’re taking: See your prescribing doctor. They can talk to you about how likely it is that your low libido is a side effect of the drug and possibly recommend potential alternatives.
If no underlying medical condition is at play: Consider seeing a sex therapist. Sex therapists have the interpersonal training and depth of expertise to “get into the nuance and the nitty gritty of the psychology of sexual desire with you the way other clinicians don’t,” Dr. Castellanos explains.
The Mayo Clinic recommends looking for a certified sex therapist with a certification from the American Association of Sexuality Educators, Counselors and Therapists (AASECT). Here’s more help for finding a sex therapist in your area.
If you’re having problems with your partner: You may not be sure whether relationship wrinkles are to blame for your low libido. Ask yourself if you still feel desire when you think about somebody else (like your celebrity crush) but not your partner, Dr. Castellanos says. If you do, that could point specifically to your relationship as your issue.
In that case, you might want to see a sex therapist or couples’ counselor. They can help you dig into dynamics that could be affecting your libido, such as poor communication in or outside the bedroom. (Not all couples’ counselors cover sex issues, though, Dr. Castellanos notes, so check about that before you make your first appointment.)
If you think you have HSDD: See any kind of clinician specializing in women’s or sexual health, Dr. Millheiser says. That includes a PCP, nurse practitioner, licensed counselor, or psychiatrist. Diagnosis involves taking a medical history, ruling out any other factors, and, ideally, using a five-question screener based on diagnostic criteria developed by the International Society for the Study of Women’s Sexual Health (ISSWSH), Dr. Millheiser says.
How to talk to someone about your libido
Discussing sex in a medical setting isn’t always easy, and doctors know this. “I tell all my patients that I know talking about your sex life is very personal, especially if it’s not going well,” Dr. Castellanos says. “You might be anxious, but remember that only by saying what the issue is [can you] get help.” Here’s how to start the conversation.
1. Bring it up right off the bat.
“It’s very important to actually say why you’re there. If you don’t start off by telling them what the problem is, they don’t know what questions to ask,” Dr. Castellanos says.
Don’t wait until the last minute to see if your doctor brings it up. Unless this is their specialty, they may not. “That doesn’t mean it’s not appropriate to talk about with them. It just means that they’re busy thinking about other aspects of your health,” Dr. Millheiser says.
2. Be straightforward and specific.
It benefits both of you to be as open and honest as possible here, Dr. Castellanos says. Try something like, “Over the last three months, my sex drive has really dropped off and I’m not sure why. My partner and I used to have sex about twice a week, but now it’s more like once a month. We’re pretty happy otherwise.” And, of course, if you are having other symptoms, like fatigue or pain with intercourse, bring those up, too.
3. Get a referral if necessary.
Some caregivers are more informed about libido or feel more comfortable talking about it than others, Dr. Castellanos says. If you’re not sure whether yours is the right person to help you or you’re not getting the care you want, Dr. Millheiser recommends asking your provider to connect you to someone else. Try something like, “If you don’t treat these things, can you refer me to somebody who does?”
“They probably know someone or can at least point you in the right direction,” Dr. Millheiser says.
And remember, your doctor has heard it all before. As Dr. Millheiser explains, “There is very little that could shock a clinician, and sexual function concerns are so common.”