Low Libido in Women

One of the sexual complaints I hear about most often from women visiting my practice, is of experiencing a low libido.

Low libido, medically termed hypoactive sexual desire disorder, is when your lack of interest in sex is recurrent or persistent and causes personal distress. Symptoms of a low sex drive in women include:

  • Having no interest in any type of sexual activity;
  • Never or only seldom having sexual fantasies or thoughts; and
  • Being concerned by your lack of sexual activity or fantasies.

But before we can say there is something wrong in your sex life, we first need to understand what ‘normal’ looks like. Sexual function and the sexual response cycle is different for men compared to women. Because of higher levels of testosterone, men have a spontaneous sexual desire. Women, on the other hand, have what we call a responsive sexual desire. This means that most women’s desire to have sex is only triggered in response to sexual stimulation. Dr Rosemary Basson describes the female sexual response cycle in terms of the following diagram:

Some women may have a spontaneous sexual drive, but for the majority of women, especially those in a long-term relationship, sexual desire generally manifests in response to sexual arousal. And for you to get aroused you will need sexual stimulation in an appropriate context. But for stimulation to lead to arousal there are certain psychological and biological processes that need to be in place. And this is where things can sometimes go wrong…

What can go wrong? Psychological and physiological barriers to sexual arousal include the following:

  1. Psychological Causes

Your state of mind can affect your sexual desire. There are several psychological causes of low sex drive, including:

  • Mental health problems, such as anxiety or depression;
  • Stress, such as financial stress or work stress;
  • Poor body image;
  • Low self-esteem;
  • History of physical or sexual abuse; and/or
  • Previous negative sexual experiences.

For many women, emotional closeness is an essential prelude to sexual intimacy. This is why difficulties in your relationship can also be a major driving factor for low sex drive. Decreased interest in sex is often the result of ongoing issues.

  1. Biological or Physical Causes

A wide range of illnesses, physical changes and medications can cause a low sex drive, including:

  • Sexual Pain

If you have pain during sex or can’t reach an orgasm, it can reduce your desire for sex. Vaginismus is one of the most common reasons for sexual pain that I see in my practice. It is caused by the involuntary contraction of the muscles around the vagina resulting in difficult or impossible penetration, entry pain, or uncomfortable insertion of the penis. You can find more information about painful sex here.

  • Medical Diseases

Many nonsexual diseases can affect sex drive, including diabetes, thyroid problems, high blood pressure, heart disease and neurological diseases.

  • Hormonal Problems

Changes in your hormone levels may alter your desire for sex. Hormone changes during pregnancy, just after having a baby and during breastfeeding can put a damper on your sex drive. After pregnancy there is a rapid drop in estrogen which can result in low libido, vaginal dryness and difficulty getting aroused. Fatigue, changes in body image, and the pressures of pregnancy or caring for a new baby also can contribute to changes in your libido. Although testosterone is a male hormone, women need it for normal sexual function. Prolactin (the hormone that aids milk production during breastfeeding) suppresses testosterone, which could eventually lead to a low libido.

  • Medications

Certain prescription drugs, especially antidepressants that are classified as selective serotonin reuptake inhibitors, are known to lower the sex drive. There are antidepressants available that do not affect sexual function, so talk to your doctor if you would like to explore an alternative option. Certain contraceptives can also result in lowered testosterone levels which can have a significant inhibiting effect on your sex life.

Female sexual function is a very complex subject because of the myriad of factors involved. Women often believe that things will get better by themselves, but this is simply not true. If you feel that you are missing out on a great sex life, or that things are not the way they used to be, talk to your doctor and get the help you need.


This article was originally written for Baby Yum Yum by Dr Jireh Serfontein.