— Experts Explain How It Can Change

By Karen Robock

There may be some times in your life when you feel as if you want to torch the sheets with your partner every night, and other times when the sexiest thing you can imagine is binge- watching baking shows. Or maybe you have sex every week or two and don’t miss it when you don’t. Meanwhile, you hear about friends who are at it every day, and think, What’s wrong with me?<

Meet the experts: Laurie Mintz, Ph.D., sex therapist and emeritus professor of psychology at the University of Florida; Susan S. Khalil, M.D., director of the Division of Sexual Health at Mount Sinai in New York City; Sally MacPhedran, M.D., director of the Women’s Sexual Health Center at MetroHealth Medical Center in Cleveland; Tami Rowen, M.D., an ob/gyn and an associate professor at the University of California San Francisco; Tameca Harris-Jackson, Ph.D., a sex therapist and director of Hope & Serenity Health Services in Altamonte Springs, FL

Well, we are here to tell you that the answer is, probably nothing. Libido, a.k.a. sex drive or sexual desire, “is multifaceted and multi- determined, encompassing biological, medical, familial, cultural, relational, and individual factors,” says sex therapist Laurie Mintz, Ph.D., an emeritus professor of psychology at the University of Florida and the author of Becoming Cliterate. With all those influences on whether you’re motivated to have sex, it makes sense that your drive can ebb and flow, even throughout a week or month (indeed, for premenopausal women, monthly cycles affect libido).

And certainly libido can vary through the broader phases of your life, says Susan S. Khalil, M.D., director of the Division of Sexual Health in the Raquel and Jaime Gilinski Department of Obstetrics, Gynecology, and Reproductive Science at Mount Sinai in New York City. When you’re in your 20s, for example, curiosity about sexuality and pleasure tend to drive up desire. Libido can plummet in the months and years after you have a baby, then rise again when the baby stops keeping you up all night. During perimenopause, women experience a natural dip in sex hormones and may start to have issues with lubrication, which can affect how into it you are. One recent study found that women’s desire tended to fluctuate more than men’s throughout their lifetimes, but that people all had similar ups and downs on a weekly basis.

What is libido, exactly?

Bear with us as we take you back to Sex 101: “Libido” is the term used to describe sexual desire or a desire for sexual activity, which may mean with a partner or the solo act of masturbation. It’s not a medical term—it was coined by Sigmund Freud, and there isn’t a universally accepted way to measure it.

That’s one of the reasons why, when it comes to libido, there is no such thing as normal. Whether yours is “healthy” is a matter of perspective, depending on what you need and want, says Sally MacPhedran, M.D., director of the Women’s Sexual Health Center at MetroHealth Medical Center in Cleveland. A high libido is as normal as a low one, regardless of gender or sexual orientation, and low sex drive is a problem only if it’s a problem for you. “There is a huge range when it comes to desire,” says Dr. MacPhedran, who often compares the spectrum of libido to the variation in height. “You don’t say somebody is abnormal at five-nine versus five-two—it’s just different.” While the term “libido” is often used interchangeably with “sex drive,” some experts take issue with the latter because it creates an unfair comparison with other primal drives, such as thirst and hunger, that are essential to survival. “You won’t die if you don’t have sex,” says Mintz. (The human species doesn’t necessarily depend on it, as sex isn’t always associated with reproduction, particularly when it comes to same-sex couples and those past childbearing age.) Understanding the need for sex requires a more nuanced grasp of the idea, says Mintz.

What hormones have to do with it

In biological terms, libido is regulated by the sex hormones testosterone and estrogen along with neurotransmitters such as norepinephrine and dopamine. Feelings of sexual desire typically begin to emerge between the ages of 9 and 15, when hormones start to surge, and continue through sexual maturity, dipping during menopause for women and tapering off in later adulthood.

These sex hormones will peak and wane through different phases of life: People who have periods will often notice a pattern in the rise and fall of their libido that’s tied to their menstrual cycle, says Tami Rowen, M.D., an ob/gyn and an associate professor at the University of California San Francisco. “Over the course of a month, a person’s sex drive will peak when they are ovulating, then drop significantly,” she says. Our hormones and neurotransmitters convey the message of desire for sex to the prefrontal cortex of the brain. But sometimes those messages can get a bit muffled. Even when our hormones peak and we are theoretically most primed for sex, we don’t always pick up on, or prioritize, what our bodies are telling us. We may be preoccupied with a sick child or simply too tired to notice (let alone heed) libido’s siren call. And that’s to be expected: Your brain is supposed to filter things to determine what your responsibilities are, what you can act on and what you can’t.

It’s also important to differentiate between the two types of desire: “What most people envision desire to look like is spontaneous sexual desire,” says Dr. MacPhedran. That’s what we read about in romance novels—when just locking eyes with someone across the room can make you excited. Responsive desire, on the other hand, is being open to saying yes to intimacy even if you’re not in the mood for sex. You may come home from work, desiring nothing but a warm bath, but when you see that your partner has brought you your favorite flowers, all of a sudden it’s Game on.

This distinction is important, because while both are part of a healthy sexual response, spontaneous desire is all we talk about and see onscreen, which can often leave people who don’t experience it thinking there’s something wrong with them. But the experts agree: There isn’t. Having responsive sexual desire—meaning you say yes when the environment is right—can result in exactly the same sexual satisfaction as spontaneous desire.

How do you feel about sex?

Your upbringing, beliefs, and negative experiences can affect your libido. “Religions and belief sets that bill sex as dirty and sinful can lead to sexual shame,” says Mintz, who points out that many women who are raised in a culture that emphasizes “purity” may struggle with these feelings even years after they’ve left that culture. A history of sexual abuse or unhealthy relationships can also affect your libido in the long term. On the other hand, some people might feel relief after leaving a culture in which they felt shamed and may find that freedom enhances their desire.

Working through negative feelings about sex or finding yourself in a positive life space can ramp up your libido as well. Maybe you’ve found a relationship in which you feel safe. Maybe you have a new, less stressful job and finally have the mental space to think about romance. Or maybe you’ve recently started taking better care of yourself and you feel physically good; this too can bump up your desire.

Reasons your drive might dip

There are numerous health and wellness issues that could be behind your dry spell. Some of the most common:

You’re stressed

This is the number one factor that affects libido in the patients of Tameca Harris-Jackson, Ph.D., a sex therapist and director of Hope & Serenity Health Services in Altamonte Springs, FL. Not only can the daily onslaught of work, money, and relationship worries dampen desire, but that often starts a negative-feedback loop in which people end up sleeping less, drinking more alcohol (a depressant that impedes sexual function), and skipping self-care.

You’re on desire-dampening meds

An estimated one in eight Americans takes antidepressants, and many don’t realize that some types of these meds can quash desire. “The worst medications for libido are certain antidepressants,” says Dr. Rowen, adding that their effects on libido are “a major reason people stop taking them.” (If you’re taking Paxil or Prozac, for example, ask your doctor about adjusting your dosage or switching to a different antidepressant.) Meds for allergies, diabetes, and high blood pressure can have an effect on sexual desire as well.

Your diet could use a reset

If you’ve ever felt bloated and not in the mood after a dinner date that featured heavy food, you know how what you eat can immediately affect your desire. Your nutrition from day to day is important too, says Harris-Jackson. “If the efficacy of blood flow is impeded by a high- sodium or high-sugar diet, there can be difficulty feeling sensation and having full function of sexual organs,” she says.

You’re on the Pill

“The idea that you can have sex for pleasure without the risk of pregnancy, certainly in this political day and age, is really important, but people should know that the birth control pill can affect libido,” says Dr. Rowen. Talk to your doctor about other reliable forms of long-term contraception, she advises.

You’re tired

According to a study in the Journal of Sexual Medicine, for some women just one more hour of shut-eye can lead to higher levels of sexual desire and better arousal the next day.

You have health challenges

>Chronic pain from arthritis or fibromyalgia, for example, may prevent you from focusing on pleasure cues. Conditions like anxiety and incontinence can also make sex more challenging.

How to boost your libido (if you want to!)

As all the experts say, your level of desire is a problem only if it bothers you. It can become an issue, though, when the libidos of partners in a romantic relationship aren’t quite in sync: If, for example, you crave sex once a week but your partner is happy with having it once a month, this is what is known as desire discrepancy—it is very common and is something you can work on together. “A difference in sex drive should be dealt with the same way as any other differences in a long-term relationship,” says Mintz: Communication and compromise are required to make everyone happy. “Especially as we age, our relationship ages, and spontaneous desire wanes, it’s often advisable for couples to jointly decide on their ideal frequency and schedule sexual encounters,” she says. Agreeing to weekly trysts, as Mintz calls them, keeps sex on the table so you don’t fall out of the habit altogether. But if you have trouble agreeing on how often to have sex, there’s unresolved tension, or one person is feeling rejected, you may wish to see a certified sex therapist. “Sexual problems are fixable—and the sooner the better, before resentments pile up,” says Mintz.

But don’t confuse this scenario with the idea that you need fixing. Historically, women have been shamed for having strong libidos (while men are applauded for the same thing), and also there is intense stigma surrounding low desire across the board. “There are a lot of stereotypes around cis women not having natural drive, but it’s unfair to describe women that way, because there is a broad range,” says Dr. Rowen. Whatever your level of desire, she says, “know that you are not broken.”

When to talk to a doctor

If your libido has changed or is bothering you, talk to your primary care provider or an ob/gyn. They may diagnose you with hypoactive sexual desire disorder (HSDD), a condition in which a decrease in or lack of sexual fantasies and desires causes personal distress. Your doc will ask questions about your medical and sexual history, may perform a physical exam to look for issues like thinning vaginal tissue or other pain-triggering concerns, recommend extra testing to rule out under lying medical issues, and refer you to a specialist before making a diagnosis.

• Making adjustments to medications that have libido-lowering side effects
• Psychotherapy such as mindfulness-based CBT
• Hormone therapy, especially for postmenopausal women
• A prescription for Vyleesi or Addyi—these two drugs are FDA-approved to boost desire in premenopausal women

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