Why interest in sex drops, which causes are fixable, and when to see a clinician. We relied on guidance from ACOG, Mayo Clinic, Cleveland Clinic and The Menopause Society.
A dip in desire rarely has just one cause. The usual suspects are medications (SSRI antidepressants and some hormonal birth control in particular), menopause, pregnancy and breastfeeding, conditions such as diabetes or thyroid problems, stress, depression and trouble in a relationship. If it lasts and it bothers you, it's a recognized condition. Many of the causes can be treated, so it's worth raising with a doctor.
Sexual interest differs from woman to woman and shifts over the years. There's no "normal" level. Wanting sex less than your partner does, or less than you once did, isn't a disorder by itself.
ACOG, the American College of Obstetricians and Gynecologists, frames female sexual dysfunction as personal distress about desire, arousal, orgasm or pain. It also observes that women rarely mention these worries unless a clinician brings them up, so plenty of women go without help that is available.
If low desire is lasting and upsetting, the diagnosis may be female sexual interest/arousal disorder (FSIAD). That's the label in the current DSM-5, which replaced the older hypoactive sexual desire disorder (HSDD) term. HSDD is still what FDA-approved treatments refer to. Both are recognized medical conditions and neither reflects a flaw in you.
Medication is among the more fixable causes, so check it first.
Never stop a prescription by yourself. Per Mayo Clinic, a doctor might lower the dose, wait to see if the side effect fades, or swap you to a different drug. For depression treatment, alternatives like bupropion are sometimes used, and bupropion can be added on top of an SSRI.
Estrogen declines through perimenopause and menopause, which can lower desire either directly or indirectly. According to The Menopause Society (formerly the North American Menopause Society), less estrogen means vaginal dryness and thinner tissue, so penetrative sex may hurt. Hot flashes and night sweats can also ruin sleep. It makes sense that either would reduce interest.
Experiences vary. Some women see a sharp drop in desire at midlife, and others notice no change or even more interest. Mayo Clinic adds that pregnancy, the months after birth and breastfeeding bring their own hormone changes, which commonly lower sex drive.
If dryness or pain plays a role, low-dose vaginal estrogen, lubricants and moisturizers are options. The Menopause Society points to evidence that testosterone may help perimenopausal and postmenopausal women with low desire, with a doctor overseeing it. In the US, testosterone isn't FDA-approved for women. Acne and extra hair growth are among the possible side effects.
Plenty of conditions unrelated to sex can still dampen desire. Mayo Clinic and Cleveland Clinic list these:
In some cases the answer is as simple as getting diabetes or high blood pressure better controlled.
For many women, desire follows mood and the state of the relationship closely. Mayo Clinic lists anxiety and depression, money or work stress, poor body image or low self-esteem, and past abuse or bad sexual experiences among the common causes.
Partner issues carry equal weight. Weak connection, unresolved conflict, poor communication and trust problems can each reduce desire, and Mayo points out that for many people closeness is the key to sexual intimacy. For that reason counseling, solo or with a partner, is a routine part of care. Therapy can also address stress, body image and the aftermath of past negative experiences, which medication can't touch.
Low desire usually has several causes, so the most effective plan tackles more than one at a time.
| Approach | Who it is for |
|---|---|
| Reviewing medications | Anyone whose desire fell after starting an antidepressant, birth control or a blood pressure drug |
| Easing dryness and pain | Women who are perimenopausal, postmenopausal or breastfeeding |
| Counseling or sex therapy | Stress, anxiety, past trauma and strain in the relationship |
| Lifestyle changes | Everyone: exercise, sleep, less alcohol and setting aside time for intimacy |
| Prescription treatment | Premenopausal women diagnosed with HSDD once other causes have been ruled out |
Two prescription drugs hold US approval for acquired, generalized HSDD in premenopausal women. The first is flibanserin (Addyi), taken as a pill every night at bedtime. Mayo Clinic names low blood pressure, drowsiness, dizziness and fatigue as side effects, and warns that drinking alcohol worsens them. The second is Vyleesi (bremelanotide), approved in 2019, an injection you give yourself at least 45 minutes before sex. In its trials, about 40% of participants had nausea. Neither drug is approved for women past menopause, and the benefits are modest. Treat them as a topic for a doctor visit, not where you start.
No libido supplement is an FDA-approved treatment for FSIAD or HSDD, and they shouldn't be thought of as one. Some women try them regardless, frequently choosing products with maca, which has small studies behind it; our maca root guide covers it. Before buying, read how to pick a product in our female libido supplement buying advice, and run the label past your doctor. Many contain herbs with hormone-like effects or drug interactions. We compare individual products in our women's libido supplements roundup and in HerSolution vs Vigorelle.
Make an appointment with a doctor, gynecologist or nurse practitioner if any of these apply:
You don't need a diagnosis before asking for help, and a partner can come along if that makes it easier. Raising it can feel awkward. Clinicians hear about it often, though, and the cause is frequently treatable.
Several things usually combine to lower desire in women: drugs such as SSRIs and hormonal birth control, hormone changes at menopause and after childbirth, medical conditions, stress, mental health and a strained relationship. If it persists and distresses you, it's a recognized condition with real treatment choices. These range from a medication change and treating dryness to counseling and, for some premenopausal women, prescription drugs. At most, supplements are a small add-on. Begin by talking openly with your doctor.