Libido (also called sex drive) means the overall interest a person has in sexual activity. It is separate from sexual arousal, which is the body’s response to sexual stimuli. A low libido does not always indicate a problem, but it may be related to a medical condition or can cause a person distress, particularly if there has been a drop in libido.
Statistics vary, but up to 20% of men experience low libido sometime in their life. Up to 43% of women experience sexual dysfunction—a problem that occurs during any part of sexual activity, from arousal to orgasm—at some point, including low libido. About 1 in 3 women report having a low sex drive.123
Low libido itself is not considered a condition. If certain criteria are met, however, a woman with low libido may be identified as having female sexual interest/arousal disorder (FSIAD).4
Some references, particularly those published before 2013, refer to low libido as hypoactive sexual desire disorder (HSDD). Since then the definitions for low libido and HSDD conditions have changed. In 2013, the official handbook that classifies mental health disorders, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), combined the two diagnoses and now refers to it as sexual interest/arousal disorder.45
Read on to learn about low libido, when it’s considered a problem, and what can be done about it.
Symptoms of Low Libido
A person with low libido may experience:6
- Little or no interest in any type of sex, including masturbation
- Rare, if any, thoughts about sex or sexual fantasies
FSIAD is marked by a lack (or serious reduction) of sexual interest or arousal in women. To meet the criteria for FSIAD, a person must show an absence or reduction in at least three of the following, for at least six months:5
- Interest in sexual activity
- Initiation of sexual activity and being unreceptive to a partner’s attempts to initiate
- Sexual or erotic thoughts and fantasies
- Sexual interest/arousal in response to sexual or erotic cues
- Sexual excitement or pleasure during sexual activity
- Genital or nongenital sensations during sexual activity
The symptoms the person experiences also must cause them clinically significant distress and not be better explained by factors such as a nonsexual mental health disorder, severe relationship distress, or another significant stressor.
<h3″>What Is the Sexual Response Cycle?
A person’s sexual response cycle has four phases:7
- Sexual desire: A person’s interest in sexual activity
- Sexual arousal: Excitement/physical response
- Orgasm (climax): Peak of sexual excitement (when pleasure is highest), and ejaculation occurs
- Resolution: The body recovers and returns to its usual state
Causes of Low Libido
A number of factors can cause low libido, including that it may be a person’s natural preference. Libido commonly lowers with age for all genders.3
>Most research on low libido focuses on cisgender men or cisgender women. More research is needed to examine low libido in people who do not fall within this narrow gender binary.
Causes of low libido may include:8916235
- Hormonal changes: Such as reduced sex hormones with aging, with hormonal contraception use, or with antihormone therapy
- Medical conditions: Such as diabetes, cardiovascular disease, fibroids, underactive thyroid, endometriosis, premenstrual syndrome (PMS)
- Medications: Including many antidepressants and antipsychotics
- Psychological distress: Stress, anxiety, exhaustion, problems with body image, etc.
- Depression: Can cause a loss of interest in things once enjoyed, including sex
- Relationship problems: Overfamiliarity with partner in long-term relationships, conflict, partner’s lack of interest/functioning in sex, etc.
- Dissatisfaction or discomfort during sexual activity: Such as erectile dysfunction, problems with ejaculation, vaginismus (involuntary tightening of the muscles around the vagina before penetration), difficulty with orgasm, vaginal dryness, or pain
- Substance misuse: Excess amounts of alcohol can affect libido, as can drug misuse and/or smoking
- Life stage or event: Such as menopause, pregnancy, postpartum, breastfeeding, loss of a loved one, retirement, job loss, divorce, illness, etc.
- Trauma: Such as a history of unwanted sexual contact or post-traumatic stress disorder (PTSD)
A 2017 study also identified high levels of chronic, intense, and greater durations of endurance training on a regular basis, as a possible contributor to decreased libido in men.10
What Medications Can Cause Low Libido?
Medications that may cause low libido include:31112
- Serotonin-enhancing medications, such as selective serotonin reuptake inhibitors (SSRIs)
- Antipsychotics, such as Haldol Decanoate (haloperidol)
- Blood pressure medications, including diuretics and beta-blockers
- Medications used to treat seizures
- Medications that block the effects or reduce the production of testosterone, such as Tagamet HB (cimetidine), Propecia (finasteride), and Androcur (cyproterone)
Is Low Libido Always a Problem?
Having a low (or no) libido in and of itself can be perfectly normal for a person. Comparing your libido to someone else’s, including your partner’s, is not an accurate way to determine if your libido is “too low.”12
There is no set amount of sex that’s considered “normal.” A person may be content thinking about or having sex once a year, while another person may be unhappy with sexual activity once a week.136
Unless your low libido is a symptom of a health condition that needs to be addressed (such as diabetes, depression, etc.), the level of your libido is only a problem if it is bothering you.2
How to Treat Low Libido
If a person wants to treat their low sex drive, there are a number of approaches that can be tried.
Hormones
Supplementation of testosterone in those with low testosterone levels may help with low libido, but should only be attempted under the guidance of a healthcare provider who is knowledgeable about this treatment.11
Those who have been through menopause (either naturally or surgically) with low libido may benefit from transdermal testosterone therapy (with or without accompanying estrogen therapy). However, data on the benefit of testosterone therapy are limited and inconsistent, and there is a lack of long-term data on safety and effectiveness.
Hormone treatment comes with risks as well as benefits. Talk to your healthcare provider about whether taking hormones is appropriate for you.1
Medication
If low libido is a side effect of medication, talk to your healthcare provider about changing the dose or type of medication you are on. In some cases, another medication, such as the atypical antidepressant Wellbutrin (bupropion), may be added to help address the sexual dysfunction.12
Flibanserin
In 2015, the Food and Drug Administration (FDA) approved the medication Addyi (flibanserin) for use in the treatment of FSIAD of any severity in people who are premenopausal.5
Reported side effects include:
- Headache
- Dizziness
- Fatigue
- Drowsiness
- Nausea
Flibanserin carries a boxed warning (the strongest FDA warning) for hypotension (low blood pressure) and syncope (fainting) in certain settings, particularly with the use of alcohol and/or moderate or strong CYP3A4 (an important drug-metabolizing enzyme) inhibitors, and for people with liver impairment.
Alcohol should be avoided during the entire course of treatment with flibanserin.
Flibanserin is taken daily as an oral pill.2</span
Long-term studies on flibanserin are needed. The benefits of flibanserin in improving sex drive are minimal compared to placebo, and in many cases are outweighed by the risks of using it.
Before taking flibanserin, it’s important to discuss these benefits vs. risks with a healthcare provider who is knowledgeable about this medication.
Bremelanotide
Vyleesi (bremelanotide) was approved in 2019 for treatment of HSDD in people who are premenopausal.14
Bremelanotide is taken as needed, about 45 minutes before sexual activity, as an injection in the thigh or abdomen.2
Evidence on efficacy is limited, and shows minimal effect on the number of satisfying sexual events compared to placebo.
The most common side effects of bremelanotide are:14
- Nausea (about 40% of people who took bremelanotide in clinical trials experienced nausea and 13% needed medication to treat the nausea)
- Vomiting
- Flushing
- Injection site reactions
- Headache
People with uncontrolled high blood pressure, with known cardiovascular disease, and those at high risk for cardiovascular disease should not take bremelanotide.
Address Underlying Medical Conditions
If your low libido is caused by a health condition, managing that condition may improve your libido.111
Therapy
Therapy such as cognitive behavior therapy (CBT) with a therapist or counselor who specializes in sexual and relationship issues may help with sexual dysfunction.121
Therapy can help you address psychological issues that may be affecting your sex drive, including:13
- Depression and other mental health issues
- Trauma, such as past sexual abuse, and other issues that are affecting how you feel about sex
- Problems with body image
Lifestyle Changes
General healthy lifestyle practices, such as eating nutritious foods, being physically active, and getting enough quality sleep, may help improve your libido.6
Mindfulness exercises, relaxation techniques, and other ways to reduce and manage stress may also be beneficial.1
For some people, engaging in sexual stimulation and triggering the arousal response can help the person “get into it,” even if they weren’t desiring sex before. While this may be helpful for some people, no one should feel pressured to engage in sexual activity if they don’t want to.12
Relationship Strategies
Open and honest communication with your partner about your sexual desires can help both of you feel sexually fulfilled.11
You may also benefit from psychosexual counseling, which can help you and your partner work through sexual, emotional, and relationship issues that may be affecting your libido.3
Remember that sex is more than intercourse. There are activities you can do together that can “spice things up” or let you engage in intimacy without having sex. Some things to try include:136
- Exploring each other’s bodies through caressing, kissing, etc.
- Giving and receiving massages
- Bathing or showering together
- Experimenting with different sexual techniques
- Using aids such as toys or massage oils
- Planning romantic activities or taking a weekend away
You may also find that self-exploration helps you find what works for you.
Are There Tests to Diagnose the Cause of Low Libido?
To look for a cause of low libido, your healthcare provider may:11
- Ask about history of low libido (when it started, severity, situational and/or medical factors around the time it started, previous treatments, and if there other sexual problems present, etc.)
- Get a general medical history, including medications and mental health
- Perform a physical examination
- Discuss your partner(s)
- Run laboratory tests, such as a blood test to check hormone levels
- Refer you to a specialist if needed (such as a mental health professional if FSIAD is suspected)
When to See a Healthcare Provider
loss of libido, especially if prolonged or recurring, may be an indication of an underlying problem. It may be a good idea to see if there are potential medical or psychological reasons that should be explored.3
Even without a medical reason, if your low libido bothers you, talk to your healthcare provider.
Summary
A low libido means little or no desire to engage in sexual activities. It may be linked to a medical condition, medication, relationship issues, hormones, and other factors. It may also be normal for that person.
Unless there is an underlying medical condition, low libido is only a problem if it causes the person distress.
Treating unwanted low libido depends on the cause, but may include medication, therapy, lifestyle changes, hormone therapy, and/or relationship building.
A Word From Verywell
If you have a low sex drive that is not caused by a medical condition and isn’t bothering you, then it is not a problem. If you are bothered by your low libido or are concerned about what may be causing it, talk to your healthcare provider. A medical professional can help you figure out what is going on and how best to approach it.
Frequently Asked Questions
- Is low libido the same as low arousal?While related, libido and arousal are different. Libido refers to a person’s overall interest in sexual activities. Sexual arousal is how the body responds to sexual stimuli (“turned on”).
- Is low libido normal?For some people, having a low libido is normal. A low libido is only a cause for concern if it is caused by a medical condition or if the person does not want to have a low libido.
- Does low libido vary by gender?
Women are more likely than men to experience low libido. The causes of low libido can also depend on gender.
Most studies on low libido include cisgender people only. More research is needed to understand how libido affects people across the gender spectrum.
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