Did you know that nearly half of women report having at least one problem with sexual function — whether its low desire, loss of arousal, trouble having an orgasm, or pain during sex?
Probably not, since it’s not something you hear much talk about.
When Lyndsey Harper, MD, first went into practice as an OB/GYN, she saw scores of women who complained about problems in the bedroom — the most common one being what they considered low sexual desire. But, though Harper had been to medical school, no one had ever taught her how to address these problems. They never talked about this in medical school.
“I had to spend 2 weeks in an erectile dysfunction clinic as a medical student, but I have no comparable training on the women’s health side, even though my focus was women’s health,” says Harper, who created Rosy, a sexual wellness app for women. “I had not been trained in how to help women with these problems and that’s the experience of most OB/GYNs across the country.”
Some doctors’ lack of expertise in this area, Harper says, perpetuates the vicious cycle that might have you feeling broken and alone right now: You’re concerned about your loss of sexual desire. You bring it up with your doctor. Your doctor is not sure how to help. So you feel like you must be the only woman in the world who has this problem.
You’re not. Not by far. Up to 1 in 3 women between the ages of 30 and 59 experience what they perceive to be low libido at some point in their lives. The cause — and the possible causes are numerous — determines how you should deal with it. But, experts say, a little reading and education can go a very long way.
Your libido is your desire or appetite for sex. Some sex therapists and doctors who specialize in sexual health talk about two different kinds of sexual desire: spontaneous and responsive.
The spontaneous kind just arises … er … spontaneously. This might be the kind of sex drive people associate with hormonal teenagers and 20-somethings. That sudden desire for sex that just washes over you seemingly out of nowhere. You know … feeling horny.
In spontaneous desire, first you think, “I want sex,” next you take action to get it (whether that’s opening up a dating app and looking for someone new, making a 3 a.m. booty call, or putting the moves on your partner who’s next to you on the couch), and then, when you’ve found the person, you get aroused. So that’s desire for sex, then seeking sex, then getting aroused.
Some women don’t feel this type of desire much after their teens and 20s. Some women don’t feel spontaneous desire at all. They only ever feel the other kind: responsive desire.
This kind of desire, as the name suggests, arises in response to some outside stimulus. It happens when you get turned on while you read an erotic story or watch a sexy movie or feel the touch of someone you’re sexually attracted to. In this one, arousal comes first and then the desire for sex and the going after it.
“Some women who think they have low sexual desire actually just don’t have the spontaneous desire they had in their teens and 20s, but they still have responsive desire,” Harper says.
Simply knowing this, Harper says, helps many women realize that they don’t really have a problem at all.
“If you do have responsive desire, then you can seek things out that your body physically responds to and induce that arousal,” Harper says. “Then you feel the physical symptoms of arousal that send the message to those neurotransmitters in the brain that then say ‘Hey, we do desire sex.’ This is why erotica works.”
There’s no “normal” sex drive. There’s not a set sexual appetite that you could label as objectively big or small. It’s also not simply that you want sex less than your partner or partners do. (Though that’s a thing, too. It’s called “mismatched” sexual desire.)
“When we talk about low sexual desire, it’s only defined personally,” Harper says. “Low sexual desire is when your desire for sex is lower than you would like it to be or lower than it was in the past and that decline in desire is bothersome for you. It has to be bothersome to you in order for it to be a problem.”
Put simply, if your sex drive, however high or low you perceive it to be, isn’t a problem for you, then it isn’t a problem at all.
In fact, don’t rush to assume that you alone are the problem at all. Studies show that in heterosexual relationships, women frequently take the blame for a dip in sexual activity that’s actually the result of a host of problems related to both members of the couple. Unfortunately, there isn’t similar research on women whose partner isn’t a man.
The issues that can boost a sex drive or wipe it out are almost innumerable. And most are not an isolated medical or physiological problem.
For starters, people’s desire for each other is at its highest early in the relationship during a phase called limerance.
“It’s that obsessive phase in a relationship when you can’t keep your hands off each other, but most people don’t know that it’s natural for that to last just 6 months to 2 years,” says Laurie Mintz, PhD, a sex therapist and author of the books Becoming Cliterate and A Tired Woman’s Guide to Passionate Sex. “So, when it ends, people miss that and may think ‘Oh my god, what’s wrong with me?’”
After this phase in a relationship passes, you may need to rely on your responsive sex drive rather than wait around for spontaneous desire to strike. That is, if you’re having trouble getting in the mood, but you want to be in the mood, pick up a paperback bodice ripper and have yourself a read.
In fact, research shows that reading about sex works. In a study of about 50 married women ages 30 to 55 with self-reported diminished sex drive, half the women had 6 weeks to read a sexual self-help book for women and the other half had 6 weeks to read a book of erotica written for women. Across both groups, women who completed the study reported increased sexual satisfaction, arousal, lubrication, orgasm, and overall sexual function, and decreased sexual pain. Although the study didn’t include women who aren’t married to their partner, it stands to reason that reading erotica of their choosing could work for them, too.
The erotic books (and to some degree the sexual self-help ones) may help because the subject matter simply turns readers on. It triggers their responsive desire. But the self-help books may do the trick, Mintz says, “because so many sexual problems are due to myths, misunderstandings, and lack of skills.”
The biggest myth, Mintz says, is that women should be able to have an orgasm through penetration alone. The fact that so many people believe this, she says, is keeping women from enjoying sex and thereby diminishing their desire for it.
“Who would want to have sex if they’re not enjoying it? If we could correct this one misunderstanding, there would be far fewer women saying that something was wrong with them,” Mintz says.
Just educating yourself about spontaneous versus responsive desire, the limerent phase of a relationship, and women’s sexual pleasure — that is, that the vast majority of women need external clitoral stimulation to have an orgasm — can lead many women to realize that they don’t have any sexual problem at all.
If reading about sex, whether in the form of self-help or erotica, works for you, you may need look no further for solutions to your problems in the bedroom.
Of course, for some people, a steamy book or adult film won’t do the trick.
About 1 in 10 women have a condition called hypoactive sexual desire disorder. This is an ongoing and bothersome lack of interest in or desire for sex for no known reason. Again, it’s only a problem if it bothers you. The FDA has approved two prescription medications for women, sometimes dubbed “female viagra,” that may help: injectable bremelanotide (Vyleesi) and oral flibanserin (Addyi).
But before you chalk your concerns up to HSDD and look into prescription drugs, doctors will want to rule out some of the commonly known reasons for loss of sexual desire.
Some problems in the bedroom call for some self-care or even some sessions with a therapist or other mental health professional.
Stress, for one, can be a menace in the bedroom. Not only is it hard to get in the mood mentally when you’re exhausted and have a lot on your mind, but research shows stress hormones in your bloodstream can also interfere with your physical ability to get aroused.
Practicing mindfulness, Mintz advises, can improve your ability to stay focused during sex so that your mind doesn’t wander to all your responsibilities and kill the mood. You may also need to explore other ways to manage stress — if it’s wrecking your sex life — through therapy, more time for yourself, or physical exercise.
“Exercise is a stress reliever. It’s good for orgasms. It gets the blood flowing. And yoga, in particular, teaches you mindfulness and, at the same time, one study found that women over 45 who practice yoga are more orgasmic,” Mintz says.
Another tip she offers for the overstressed is to schedule sex. No, it doesn’t sound very sexy. But rather than think of it like another business meeting on your calendar, she says, “Think of it as a tryst — a planned meeting between lovers. This allows you to plan, save the energy, fantasize, and do whatever you need to do to get into that headspace.”
Other libido killers on the psychological or emotional end of the spectrum include anxiety and depression. Past sexual trauma or past conditioning about sex, such as an upbringing that taught you sex was dirty or immoral, can impact your desire for sex also. Relationship problems can hurt your sex life, too, whether it’s a conflict between you and your partner, a loss of attraction to them, or that you have taken on their sexual problems.
“If a partner has a sexual problem, that can turn into your own sexual dysfunction over time,” Harper says.
Body image problems can take a toll on your sex drive, too. You could be unhappy with the way you look because of weight loss, weight gain, or illness, and not want to be physically intimate. Or if you’ve had a mastectomy or surgery to remove reproductive organs, this can change the way you see yourself sexually.
Some of these issues may require therapy, either individually or with your partner, and addressing them could help you get your sex life to where you want it to be.
Pregnancy, post-partum, and menopause can each have an impact on your sex drive for many reasons. Your hormone levels change during these times. You have new stressors in your life. You may not be getting much sleep. You may not feel as confident or comfortable in your body. You could have pain during sex, too. Your sex drive can take a hit from any of these alone, so imagine what might happen when you have a few of these issues happening together.
The constellation of issues that arise during these major life changes may require a multifaceted approach that could include therapy, couples counseling, lubrication, hormone replacement therapy, and pelvic floor exercises.
Certain medications can diminish your appetite for sex. They include both SSRI and SNRI antidepressants; prescription meds for heart failure, blood pressure, and high cholesterol; seizure medications; medications for mood disorders and mental illnesses; and over-the-counter medications for heartburn.
In most cases, there are many different kinds of medications to treat the same condition. So, if you think your desire for sex dropped after you started taking a new medication, ask your doctor whether the sexual side effects will go away or whether you can switch to something else. But don’t just stop taking your medications. The consequences of untreated illnesses can be worse than low sexual desire, and untreated illnesses can take a toll on sex drive, too.
Case in point: “People who have untreated depression have worse sexual function than people who are treated,” Harper says.
As you try to figure out why your sex drive isn’t what you’d like it to be, Harper recommends you go for the low-hanging fruit first. That is, before you see your doctor in search of a diagnosable medical problem, try a little self-education. Also, see if erotic books or movies help put you in the mood. Explore whether better stress management improves the situation.
You may learn that what you thought was a sex problem was just a misconception. Or maybe it’s something more than that.
“Some sexual problems definitely benefit from a multidisciplinary approach,” Harper says. “The woman empowers herself through education. The physician oversees medication changes. The therapist is looking after the relationship or attitudes about sex.”
